Anestesia em paciente com saturnismo: relato de caso

Luís Mauro Alvim de Lima; Flávio Castro Resende; Ana Carolina Janiques dos Santos; Patricia Pimentel Duarte Rodrigues Terra; Alberto Vieira Pantoja; Marco Antonio Cardoso de Resende

doi:10.1590/S0034-70942012000600011

Clinical Information

Anestesia em paciente com saturnismo: relato de caso

Anesthesia in patient with lead poisoning: case report

Luís Mauro Alvim de Lima; Flávio Castro Resende; Ana Carolina Janiques dos Santos; Patricia Pimentel Duarte Rodrigues Terra; Alberto Vieira Pantoja; Marco Antonio Cardoso de Resende

http://dx.doi.org/10.1590/S0034-70942012000600011 Braz J Anesthesiol, vol.62, n6, p.866-868, 2012

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Resumo

JUSTICATIVA E OBJETIVOS: O saturnismo decorre da intoxicação crônica pelo chumbo, comum após exposição ocupacional. Projéteis retidos no corpo podem resultar em elevados níveis plasmáticos de chumbo com inúmeras repercussões clínicas, principalmente neurológicas. Apresentamos um caso de paciente sintomático, sem diagnóstico, que foi detectado durante visita pré-anestésica. RELATO DO CASO: Paciente apresentado para retirada de projétil alojado em joelho esquerdo há 14 anos, com polineuropatia sem investigação. Durante visita pré-anestésica foi levantada a hipótese de saturnismo, confirmada pelos altos níveis plasmáticos de chumbo (129 µg.dL-1). A cirurgia foi realizada sob anestesia geral antes do início da quelação do chumbo. Durante indução anestésica, o paciente evoluiu com apneia, sem rigidez torácica após 50 µg de fentanil. CONCLUSÃO: A intoxicação por chumbo interfere com a função de diversos órgãos e sistemas, altera o metabolismo oxidativo e os mecanismos intracelulares de sinalização. O acometimento neurológico, com redução da condução neural merece especial atenção do anestesiologista.

Palavras-chave

ANESTESIA, Geral, DOENÇAS, Raras, saturnismo, TOXICIDADE, chumbo

Abstract

BACKGROUND AND OBJECTIVES: Lead poisoning, also Saturnism, results from chronic lead poisoning, common after occupational exposure. Projectiles retained in the body may result in increased levels of plasma lead with numerous clinical implications, particularly neurological. We report a case of a symptomatic patient, undiagnosed, whose diagnosis was made during the preanesthesia evaluation. CASE REPORT: The patient was attended at our hospital to remove a bullet lodged in his left knee 14 years ago, presenting with polyneuropathy without investigation. During the preanesthetic visit, saturnism was hypothesized and confirmed by high plasma lead levels (129 µg.dL-1). Surgery was performed under general anesthesia before starting lead chelation. During anesthesia, the patient developed apnea, without chest-wall rigidity after administration of fentanyl (50 mg). CONCLUSION: Lead poisoning interferes with the function of various organs and systems, alters oxidative metabolism and intracellular signaling mechanisms. Neurological involvement, with reduced neural conduction, deserves special attention from anesthesiologists.

Keywords

Anesthesia, General, Lead Poisoning, Toxicity Tests

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Anestesia em paciente com saturnismo: relato de caso

Anesthesia in patient with lead poisoning: case report

Luís Mauro Alvim de Lima; Flávio Castro Resende; Ana Carolina Janiques dos Santos; Patricia Pimentel Duarte Rodrigues Terra; Alberto Vieira Pantoja; Marco Antonio Cardoso de Resende

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