Uso do bloqueio combinado raqui-peridural durante cirurgia de cólon em paciente de alto risco: relato de caso

Luiz Eduardo Imbelloni; Marcos Fornasari; José Carlos Fialho

doi:10.1590/S0034-70942009000600010

Clinical Information

Uso do bloqueio combinado raqui-peridural durante cirurgia de cólon em paciente de alto risco: relato de caso

Combined spinal epidural anesthesia during colon surgery in a high-risk patient: case report

Luiz Eduardo Imbelloni; Marcos Fornasari; José Carlos Fialho

http://dx.doi.org/10.1590/S0034-70942009000600010 Braz J Anesthesiol, vol.59, n6, p.741-745, 2009

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Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio combinado raqui-peridural (BCRP) oferece vantagens sobre a anestesia peridural ou subaracnóidea com injeção única. O objetivo deste relato foi apresentar um caso onde a anestesia subaracnóidea segmentar pode ser técnica efetiva para intervenção cirúrgica gastrintestinal com respiração espontânea. RELATO DO CASO: Paciente estado físico ASA III, diabetes mellitus tipo II, com hipertensão arterial sistêmica e doença pulmonar obstrutiva crônica, foi escalada para ressecção de tumor de cólon direito. O BCRP foi realizado no interespaço T5 - T6 e foram injetados 8 mg de bupivacaína a 0,5% isobárica acrescida de 50 µg de morfina no espaço subaracnóideo. O cateter peridural (20G) foi introduzido quatro centímetros em direção cefálica. Foi obtida sedação com doses fracionadas de 1 mg de midazolam (total de 6 mg). Bupivacaína a 0,5% foi administrada em bolus de 25 mg através do cateter duas horas após a anestesia subaracnóidea. Não houve necessidade de vasopressor nem atropina. CONCLUSÕES: Este caso proporciona evidências de que a raquianestesia segmentar pode ser uma técnica anestésica para operação gastrintestinal com respiração espontânea.

Palavras-chave

CIRURGIA, Abdominal, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Combined spinal epidural anesthesia (CSEA) has advantages over single injection epidural or subarachnoid blockades. The objective of this report was to present a case in which segmental subarachnoid block can be an effective technique for gastrointestinal surgery with spontaneous respiration. CASE REPORT: Patient with physical status ASA III, with diabetes mellitus type II, hypertension, and chronic obstructive pulmonary disease was scheduled for resection of a right colon tumor. Combined spinal epidural block was performed in the T5-T6 space and 8 mg of 0.5% isobaric bupivacaine with 50 µg of morphine were injected in the subarachnoid space. The epidural catheter (20G) was introduced four centimeters in the cephalad direction. Sedation was achieved with fractionated doses of 1 mg of midazolam (total of 6 mg). A bolus of 25 mg of 0.5% bupivacaine was administered through the catheter two hours after the subarachnoid block. Vasopressors and atropine were not used. CONCLUSIONS: This case provides evidence that segmental spinal block can be the anesthetic technique used in gastrointestinal surgeries with spontaneous respiration.

Keywords

ANESTHETIC TECHNIQUES, Regional, SURGERY, Abdominal

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Uso do bloqueio combinado raqui-peridural durante cirurgia de cólon em paciente de alto risco: relato de caso

Combined spinal epidural anesthesia during colon surgery in a high-risk patient: case report

Luiz Eduardo Imbelloni; Marcos Fornasari; José Carlos Fialho

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