Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000300008
Brazilian Journal of Anesthesiology
Clinical Information

Anestesia subaracnóidea para cesariana em paciente portadora de esclerose múltipla: relato de caso

Subarachnoid anesthesia for cesarean section in a patient with multiple sclerosis: case report

Fabiano Timbó Barbosa; Ronaldson Correia Bernardo; Rafael Martins da Cunha; Maria do Socorro Melo Pedrosa

http://dx.doi.org/10.1590/S0034-70942007000300008 Braz J Anesthesiol, vol.57, n3, p.301-306, 2007
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Resumo

JUSTIFICATIVA E OBJETIVOS: A esclerose múltipla é uma doença adquirida que se caracteriza por áreas desmielinizadas no encéfalo e na medula espinal. O quadro clínico depende das áreas anatômicas acometidas. As principais causas de morte são infecção, falência respiratória e estado de mal epiléptico. Ocorre em pacientes geneticamente predispostos após contato com fatores ambientais, principalmente os vírus. O objetivo desse relato foi apresentar a técnica anestésica adotada em paciente com esclerose múltipla submetida à cesariana. RELATO DO CASO: Paciente com 32 anos, 60 kg, portadora de esclerose múltipla, tratada com metilprednisolona, deu entrada no centro obstétrico para realização de cesariana. Após monitoração foi realizada anestesia subaracnóidea com bupivacaína a 0,5% hiperbárica (12,5 mg) associada à morfina (0,1 mg). O procedimento evoluiu sem intercorrências e a paciente recebeu alta hospitalar 48 horas após o parto sem piora dos sintomas preexistentes. CONCLUSÕES: O presente caso sugere que a raquianestesia pode ser administrada em paciente portador de esclerose múltipla sem a ocorrência obrigatória de exacerbações agudas dos sintomas no período pós-operatório.

Palavras-chave

DOENÇA, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Multiple sclerosis is an acquired disease characterized by demyelinated areas in the brain and spinal cord. The clinical presentation depends on the anatomical areas involved. The main causes of death are infection, respiratory failure, and status epilepticus. It affects genetically predisposed patients after contact with environmental factors, especially viruses. The objective of this report was to present the anesthetic technique used in a patient with multiple sclerosis undergoing cesarean section. CASE REPORT: A 32-year old patient, 60 kg, with multiple sclerosis, treated with methylprednisolone, was admitted to the obstetric ward for a cesarean section. After monitoring, subarachnoid anesthesia was performed with 0.5% hyperbaric bupivacaine (12.5 mg) associated with morphine (0.1 mg). The procedure evolved without any intercurrences and the patient was discharged from the hospital 48 hours after delivery without worsening of her symptoms. CONCLUSIONS: This case suggests that spinal anesthesia can be administered in patients with multiple sclerosis without the acute worsening of their symptoms in the postoperative period.

Keywords

ANESTHETIC TECHNIQUES, Regional, DISEASES

References

Dierdorf SF. Anestesia para pacientes com doenças raras e coexistentes. Anestesia Clínica. 2004:491-520.

Rudick RA. Esclerose múltipla e distúrbios relacionados. Cecil Tratado de Medicina Interna. 2001:2387-2396.

Stoelting RK, Dierdorf SF. Diseases of the Nervous System. Anesthesia and Co-existing Disease. 2002:233-298.

Perlas A, Chan VWS. Neuraxial anesthesia and multiple sclerosis. Can J Anesth. 2005;52:454-458.

Al Satli RA, Samarkandi AH. Anesthesia for multiple sclerosis in a patient undergoing correction of ASD: A case report. Middle East J Anesthesiol,. 1999;15:91-98.

Martz Jr DG, Schreibman DL, Matjasko MJ. Neurologic Diseases. Anesthesia and Uncommon Diseases. 1998:3-37.

Iglesia-Gonzales JL, Barredo-Abellon J, Garcia-Velasco P. Esclerosis múltiple y anestesia. Rev Esp Anestesiol Reanim. 1997;44:334.

Warren TM, Datta S, Ostheimer GW. Lumbar epidural anesthesia in a patient with multiple sclerosis. Anesth Analg. 1982;61:1022-1023.

Baranov D, Kelton T, Mc Clung H. Neurologic diseases. Anesthesia and Uncommon Diseases. 2006:261-301.

Bader AM, Hunt CO, Datta S. Anesthesia for the obstetric patient with multiple sclerosis. J Clin Anesth. 1988;1:21-24.

Finucane BT, Terblanche OC. Prolonged duration of anesthesia in a patient with multiple sclerosis following paravertebral block. Can J Anesth. 2005;52:493-497.

Leigh J, Fearnley SJ, Lupprian KG. Intrathecal diamorphine during laparotomy in a patient with advanced multiple sclerosis. Anaesthesia. 1990;43:640-642.

Berger JM, Ontell R. Intrathecal morphine in conjunction with a combined spinal and general anesthetic in a patient with multiple sclerosis. Anesthesiology. 1987;66:400-402.

Wang A, Sinatra RS. Epidural anesthesia for cesarean section in a patient with von Hippel Lindau disease and multiple scleroses. Anesth Analg. 1999;88:1083-1084.

Mathias RS, Torres MLA. Analgesia e Anestesia em Obstetrícia. Anestesiologia SAESP. 2001:679-730.

Morgan Jr GE, Mikhail MS. Controle da dor. Anestesiologia Clínica. 2003:262-302.

Dalmas AF, Texier C, Ducloy-Bouthors AS. Obstetrical analgesia and anaesthesia in multiple sclerosis. Ann Fr Anesth Rean. 2003;22:861-864.

Watt JWH. Anaesthesia for chronic spinal cord lesions and multiple sclerosis. Anaesthesia. 1998;53:825-826.

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