Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942008000400004
Brazilian Journal of Anesthesiology
Scientific Article

A anestesia peridural torácica realizada com segurança no paciente anestesiado: estudo de uma série de casos

Thoracic epidural block performed safely in anesthetized patients: a study of a series of cases

Paulo Roberto Nunes de Bessa; Verônica Vieira da Costa; Érika Carvalho Pires Arci; Maria do Carmo Barretto de C. Fernandes; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942008000400004 Braz J Anesthesiol, vol.58, n4, p.354-362, 2008
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Resumo

JUSTIFICATIVA E OBJETIVOS: O surgimento de casos de paraplegia seguindo a inserção de cateter peridural em pacientes anestesiados levou a questionamento por parte de alguns autores, mesmo que não se confirme que a lesão tenha ocorrido porque o paciente estava anestesiado. Por esse motivo, idealizamos este estudo, que teve como objetivo avaliar a freqüência de complicações neurológicas e de surgimento de seqüelas após anestesia peridural torácica realizada com os pacientes sob anestesia geral. MÉTODO: Participaram do estudo pacientes submetidos à intervenção cirúrgica torácica no período de 16/02/2004 a 30/05/2006. Após monitoração dos sinais vitais e realização da anestesia geral, os pacientes foram colocados em decúbito lateral e realizada anestesia peridural torácica simples ou contínua. Numa ficha especial foram registradas as intercorrências, complicações e dificuldades na realização da técnica. No pós-operatório os pacientes foram acompanhados em busca de sinais e sintomas de disfunção neurológica. RESULTADOS: Foram avaliados 113 pacientes e em 108 foi inserido cateter peridural torácico. Em 45 pacientes a punção foi considerada traumática, ou seja, sangramento no local da punção e punções múltiplas. Em dois pacientes houve perfuração acidental de dura-máter. No pós-operatório imediato um paciente relatou sensação de formigamento em membros inferiores, outro paciente apresentou dormência em membro superior, desaparecendo com a retirada e tração do cateter. A punção foi única nos dois casos. Nenhum outro paciente apresentou sinais ou sintomas de alterações neurológicas. CONCLUSÕES: Nos casos estudados não houve complicação neurológica. Quando executado com bom senso e cuidados específicos o bloqueio peridural torácico pode ser realizado com segurança no paciente anestesiado.

Palavras-chave

ANESTESIA, Geral, COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: The development of paraplegia following the insertion of epidural catheter in anesthetized patients raised questions by some authors about the procedure, even without the confirmation that the lesion occurred because the patient was anesthetized. For this reason, we designed this study, with the objective to evaluate the frequency of neurological complications and development of sequelae after thoracic epidural block in patients under general anesthesia. METHODS: Patients undergoing thoracic surgeries from 02/16/2004 to 05/30/2006 participated in the study. After monitoring vital signs and the installation of general anesthesia, patients were placed in lateral decubitus for simple or continuous thoracic epidural block. Intercurrences, complications, and technical difficulties were recorded on a special form. Patients were followed postoperatively to detect the development of any signs and symptoms of neurological dysfunction. RESULTS: One hundred and thirteen patients were evaluated and the thoracic epidural catheter was placed in 108 patients. The puncture was considered traumatic, i.e., bleeding at the puncture site and multiple punctures, in 45 patients. Accidental perforation of the dura-mater occurred in two patients. In the immediate postoperative period, a patient complained of tingling in the lower limbs, another patient developed numbness in an upper limb, which resolved after the catheter was removed. Both patients had a single puncture. The other patients did not develop any signs or symptoms of neurologic changes. CONCLUSIONS: The cases studied here did not develop any neurologic complications. When performed judiciously and with specific care, thoracic epidural block can be safely done in the anesthetized patient.

Keywords

ANESTHESIA, General, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, COMPLICATIONS

References

Drasner K. Thoracic epidural anesthesia: asleep at the wheal?. Anesth Analg. 2004;99:578-579.

Bromage PR, Benumof JL. Paraplegia following intracord injection during attempted epidural anesthesia under general anaesthesia. Reg Anesth Pain Med. 1998;23:104-107.

Mayall MF, Calder I. Spinal cord injury following an attempted thoracic epidural. Anaesthesia. 1999;54:990-994.

O´Higgins F, Tuckey JP. Thoracic epidural anaesthesia and analgesia: United Kingdom practice. Acta Anaesthesiol Scand. 2000;44:1087-1092.

Fischer HBJ. Regional anaesthesia before or after general anaesthesia?. Anaesthesia. 1998;53:727-729.

Bromage P. The control of post thoracotomy pain. Anaesthesia. 1989;44:445.

Vaughan RS, Gough JD. The control of post thoracotomy pain: a reply. Anaesthesia. 1989;44:445-446.

Tsui BCH, Armstrong K. Can direct cord injury occur without paresthesia?: A report of delayed spinal cord injury after epidural placement in an awake patient. Anesth Analg. 2005;101:1212-1214.

Krane EJ, Dalens BJ, Murat I. The safety of epidurals placed during general anesthesia. Reg Anesth Pain Med. 1998;23:433-438.

Horlocker TT, Abel MD, Messick JM. Small risk of serious neurologic complications related to lumbar epidural catheter placement in anesthetized patients. Anesth Analg. 2003;96:1547-1552.

Auroy Y, Narchi P, Messiah A. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997;87:479-486.

Simon SL, Abrahams JM, Sean GM. Intramedullary injection of contrast into the cervical spinal cord during cervical myelography: a case report. Spine. 2002;27:E274-277.

Hamandi K, Mottershead J, Lewis T. Irreversible damage to the spinal cord following spinal anesthesia. Neurology. 2002;59:624-626.

Brull R, McCartney CJL, Chan VWS. Disclosure of risks associated with regional anesthesia: a survey of academic regional anesthesiologists. Reg Anesth Pain Med. 2007;32:7-11.

Moen V, Dahlgren N, Irestedt L. Severe neurological complications after central neuraxial blockades in Sweden 1990-1999. Anesthesiology. 2004;101:950-959.

Auroy Y, Benhamou D, Barques L. Major complications of regional anesthesia in France: the SOS regional anesthesia hotline service. Anesthesiology. 2002;97:1274-1280.

Costa VV, Rodrigues MR, Saraiva RA. Complicações e seqüelas neurológicas da anestesia regional realizada em crianças sob anestesia geral: um problema real ou casos esporádicos?. Rev Bras Anestesiol. 2006;56:583-590.

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