Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000100010
Brazilian Journal of Anesthesiology
Clinical Information

Anestesia para implante de marca-passo em paciente adulto com ventrículo único não-operado: relato de caso

Anesthesia for pacemaker implant in an adult patient with unoperated univentricular heart: case report

Adriano Bechara de Souza Hobaika; André Luís Pontes Procópio; Marcelo Luiz Souza Pereira; Aristóteles Pereira Coimbra; Magda Lourenço Fernandes; Kleber Costa de Castro Pires

http://dx.doi.org/10.1590/S0034-70942007000100010 Braz J Anesthesiol, vol.57, n1, p.90-93, 2007
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Resumo

JUSTIFICATIVA E OBJETIVOS: Ventrículo único é anormalidade rara encontrada em cerca de 1% dos pacientes com cardiopatia congênita. Somente 11 casos de pacientes com ventrículo único não-operado e idade acima de 50 anos foram relatados na literatura. Este trabalho teve como objetivo descrever a conduta anestésica em paciente com ventrículo único para implante de marca-passo. RELATO DO CASO: Paciente do sexo feminino, 47 anos, com presença de dupla via de entrada do ventrículo esquerdo, L-transposição de grandes artérias e estenose subpulmonar, sem correção cirúrgica prévia, foi agendada para implante de marca-passo cardíaco definitivo seqüencial de duas câmaras. Ao MAPA apresentava bloqueio atrioventricular de segundo grau e uma freqüência cardíaca média de 45 bpm. Os exames pré-operatórios mostravam hematócrito de 57%, coagulograma normal, função ventricular preservada. A monitorização constou de oxímetro de pulso, ECG nas derivações D II e V5, PIA, capnógrafo e analisador de gases. Um marca-passo temporário transcutâneo foi disponibilizado no caso de bradicardia intensa. A anestesia foi induzida com fentanil (0,25 mg), etomidato (20 mg) e atracúrio (35 mg). Quatro minutos após a indução, a freqüência cardíaca diminuiu para 30 bpm, sendo administrado 1 mg de atropina, com reversão da bradicardia. A anestesia foi mantida com sevoflurano a 2,5%, ar 60% e oxigênio 40%. O estado hemodinâmico e a saturação de oxigênio permaneceram estáveis. A paciente foi encaminhada à unidade de terapia intensiva estável e extubada ao final do procedimento. CONCLUSÕES: A conduta anestésica para implante de marca-passo em paciente de 47 anos com dupla via de entrada do ventrículo esquerdo e estenose subpulmonar não-operada foi adequada, haja vista que permitiu a realização do procedimento indicado.

Palavras-chave

CIRURGIA, Cardíaca, DOENÇAS, Congênita

Abstract

BACKGROUND AND OBJECTIVES: Single ventricle is a rare abnormality, affecting 1% of the patients with congenital cardiopathy. Only 11 cases of patients with unoperated univentricular heart older than 50 years were reported in the literature. The aim of this report was to describe the anesthetic conduct in a patient with univentricular heart undergoing pacemaker implant. CASE REPORT: A female patient, 47 years old, with double outlet left ventricle, L-transposition of the great vessels, and pulmonary stenosis, without prior surgical correction, was scheduled for definitive implant of a sequential dual-chamber pacemaker. The ABPM demonstrated second degree atrioventricular block and a mean heart rate of 45 bpm. Preoperative exams showed a hematocrit of 57%, normal coagulation studies, and preserved ventricular function. Monitoring consisted of pulse oxymeter, ECG on D II and V5, IBP, capnograph, and gas analyzer. A temporary transcutaneous pacemaker was available in case of severe bradycardia. Anesthesia was induced with fentanyl (0.25 mg), etomidate (20 mg), and atracurium (35 mg). Four minutes after anesthetic induction, the heart rate decreased to 30 bmp and 1 mg of atropine was administered with reversal of the bradycardia. Anesthesia was maintained with 2.5% sevoflurane, 60% room air, and 40% oxygen. Hemodynamic parameters and oxygen saturation remained stable. The patient was transferred to the intensive care unit in stable condition and extubated at the end of the procedure. CONCLUSIONS: The anesthetic conduct for pacemaker implant in a 47-year old patient with non-operated double outlet left ventricle and pulmonary stenosis was appropriate, since it allowed the procedure to be performed.

Keywords

DISEASES. Congenital, SURGERY, Cardiac

Referencias

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