Raquianestesia contínua com altas doses de anestésicos locais
Autor(a) principal: | |
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Data de Publicação: | 2010 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Institucional da UNESP |
Texto Completo: | http://dx.doi.org/10.1590/S0034-70942010000500010 http://hdl.handle.net/11449/140328 |
Resumo: | Background and objectives: Better control of the level, intensity, and duration of spinal analgesia represents the greatest advantages of continuous spinal anesthesia. With the advent of intermediate catheters (over-the-needle catheter) and its low incidence of headaches and neurological symptoms, the technique has been gaining credibility. The objective of this paper is to report the possible safety of the new catheter with a large dose of hyperbaric 0.5% bupivacaine with 1.6% glucose associated with hyperbaric 2% lidocaine with 1.6% glucose. Case Report: Male patient, 78 years old, 85 kg, 168 cm, physical status ASA III, with hypertension, coronary artery disease, and chronic renal failure. The patient was candidate for surgery for huge bilateral inguinal and umbilical hernias, being submitted to preoperative pneumoperitoneum for one week to stretch abdominal cavity. After venoclysis with an 18G catheter, he was monitored with cardioscope, non-invasive blood pressure, and pulse oximetry; he was sedated with 1 mg of midazolam and 100 µg of fentanyl intravenously, and placed in left lateral decubitus. He underwent continuous spinal anesthesia by a median puncture in L3-L4 with a set with a 27G cut-bevel needle and 22G catheter. The total dose of anesthetic used was 25 mg of 0.5% bupivacaine (hyperbaric, with 1.6% glucose), 160 mg of 2% lidocaine (hyperbaric, with 1.6% glucose), and morphine (100 µg). The patient was followed-up until the 30th postoperative day without neurological complaints. Conclusions: Recently, the poor distribution of the local anesthetic through the microcatheter was attributed as the cause of cauda equina syndrome. This case report showed that, with the administration of high doses of hyperbaric anesthetics through the new catheter, poor distribution or risk of cauda equina syndrome were not observed. |
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Raquianestesia contínua com altas doses de anestésicos locaisContinuous spinal anesthesia with high dose of local anestheticsAnesthesicLocal: bupivacaine, lidocaineAnesthesic techniqueRegional: continuous spinal anesthesiaSurgeryAbdominal: herniorrhaphyAnestésicoLocal: bupivacaína, lidocaínaCirurgiaAbdominal: herniorrafiaTécnicas anetésicasRegional: raquianestesia contínuaBackground and objectives: Better control of the level, intensity, and duration of spinal analgesia represents the greatest advantages of continuous spinal anesthesia. With the advent of intermediate catheters (over-the-needle catheter) and its low incidence of headaches and neurological symptoms, the technique has been gaining credibility. The objective of this paper is to report the possible safety of the new catheter with a large dose of hyperbaric 0.5% bupivacaine with 1.6% glucose associated with hyperbaric 2% lidocaine with 1.6% glucose. Case Report: Male patient, 78 years old, 85 kg, 168 cm, physical status ASA III, with hypertension, coronary artery disease, and chronic renal failure. The patient was candidate for surgery for huge bilateral inguinal and umbilical hernias, being submitted to preoperative pneumoperitoneum for one week to stretch abdominal cavity. After venoclysis with an 18G catheter, he was monitored with cardioscope, non-invasive blood pressure, and pulse oximetry; he was sedated with 1 mg of midazolam and 100 µg of fentanyl intravenously, and placed in left lateral decubitus. He underwent continuous spinal anesthesia by a median puncture in L3-L4 with a set with a 27G cut-bevel needle and 22G catheter. The total dose of anesthetic used was 25 mg of 0.5% bupivacaine (hyperbaric, with 1.6% glucose), 160 mg of 2% lidocaine (hyperbaric, with 1.6% glucose), and morphine (100 µg). The patient was followed-up until the 30th postoperative day without neurological complaints. Conclusions: Recently, the poor distribution of the local anesthetic through the microcatheter was attributed as the cause of cauda equina syndrome. This case report showed that, with the administration of high doses of hyperbaric anesthetics through the new catheter, poor distribution or risk of cauda equina syndrome were not observed.Justificativa y objetivos: La mayor ventaja de la raquianestesia continua es el mejor control del nivel de intensidad y duración de la analgesia espinal. Con el advenimiento de los catéteres intermediarios (catéter por fuera de la aguja) y por su baja incidencia de cefalea y síntomas neuroló- gicos, la técnica ha venido ganando credibilidad. El objetivo de este caso es relatar la posible seguridad del uso del nuevo catéter con una gran dosis de bupivacaína hiperbárica al 0,5% con glucosa al 1,6% asociada a la lidocaína al 2% hiperbárica y con glucosa al 1,6%. Relato del caso: Paciente masculino, de 78 años, 85 kg, 168 cm, estado físico ASA III, hipertenso, con coronariopatía e insuficiencia renal crónica. Candidato a cirugía de voluminosas hernias inguinales bilateral y umbilical, siendo sometido durante una semana a neumoperitoneo para crear espacio. Posteriormente a la venoclisis con catéter 18G, monitorización con cardioscopio, presión arterial no invasiva y oximetria de pulso, fue sedado con 1 mg de midazolam y fentanil 100 µg por vía venosa y colocado en decúbito lateral izquierdo. Sometido a la raquianestesia continua por vía mediana en L3-L4, y conjunto de aguja cortante 27G con catéter 22G. La dosis total de anestésico utilizada en el procedimiento fue 25 mg de bupivacaína al 0,5% (hiperbárica con glucosa al 1,6%) y 160 mg de lidocaína al 2% (hiperbárica con glucosa al 1,6%) y morfina (100 µg). Paciente con seguimiento hasta el 30º día sin quejidos neurológicos. Conclusiones: Recientemente, la mala distribución del anestésico local a través de microcatéter, se atribuyó a una causa del síndrome de cola de caballo. Este relato de caso mostró que, con la administración de altas dosis de anestésicos hiperbáricos a través del nuevo catéter, no hubo una mala distribución ni el riesgo de síndrome de cola de caballo.Justificativa e objetivos: A maior vantagem da raquianestesia contínua é o melhor controle de nível, intensidade e duração da analgesia espinal. Com o advento dos cateteres intermediários (cateter por foral da agulha) e sua baixa incidência de cefaleia e sintomas neurológicos, a técnica vem ganhando credibilidade. O objetivo de caso é relatar a possível segurança do uso do novo cateter com grande dose de bupivacaína hiperbárica a 0,5% com glicose a 1,6% associada à lidocaína 2% hiperbárica com glicose a 1,6%. Relato do caso: Paciente do sexo masculino, 78 anos, 85 kg, 168 cm, estado físico ASA III, hipertenso, coronariopata e insuficiência renal crô- nica. Candidato à cirurgia de volumosas hérnias inguinal bilateral e umbilical, sendo submetido por uma semana a pneumoperitôneo para criar espaço. Após venóclise com cateter 18G, monitoração com cardioscópio, pressão arterial não invasiva e oximetria de pulso, foi sedado com 1 mg de midazolam e fentanil 100 µg por via venosa e colocado em decúbito lateral esquerdo. Submetido à raquianestesia contínua por via mediana em L3-L4, com conjunto de agulha cortante 27G e cateter 22G. A dose total de anestésico utilizada no procedimento foi 25 mg de bupivacaína 0,5% (hiperbárica com glicose a 1,6%) e 160 mg de lidocaína 2% (hiperbárica com glicose a 1,6%) e morfina (100 µg). Paciente acompanhado até o 30º dia sem queixa neurológica. Conclusões: Recentemente, a má distribuição do anestésico local através de microcateter foi atribuída como causa de síndrome de cauda equina. Este relato de caso mostrou que, com a administração de altas doses de anestésicos hiperbáricos através do novo cateter, não houve má distribuição nem risco de síndrome de cauda equina.Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Anestesiologia, Botucatu, SP, BrasilUniversidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Faculdade de Medicina de Botucatu (FMB), Departamento de Anestesiologia, Botucatu, SP, BrasilUniversidade Estadual Paulista (Unesp)Imbelloni, Luiz EduardoGasparini Neto, SavinoGanem, Eliana Marisa [UNESP]2016-07-07T12:33:20Z2016-07-07T12:33:20Z2010info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/article537-543application/pdfapplication/pdfhttp://dx.doi.org/10.1590/S0034-70942010000500010Revista Brasileira de Anestesiologia, v. 60, n. 5, p. 537-543, 2010.0034-7094http://hdl.handle.net/11449/14032810.1590/S0034-70942010000500010S0034-70942010000500010S0034-70942010000500010-pt.pdfS0034-70942010000500010-en.pdf822694213076882082269421307688208226942130768820Currículo Lattesreponame:Repositório Institucional da UNESPinstname:Universidade Estadual Paulista (UNESP)instacron:UNESPporRevista Brasileira de Anestesiologia0.8500,320info:eu-repo/semantics/openAccess2024-01-04T06:22:48Zoai:repositorio.unesp.br:11449/140328Repositório InstitucionalPUBhttp://repositorio.unesp.br/oai/requestopendoar:29462024-01-04T06:22:48Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP)false |
dc.title.none.fl_str_mv |
Raquianestesia contínua com altas doses de anestésicos locais Continuous spinal anesthesia with high dose of local anesthetics |
title |
Raquianestesia contínua com altas doses de anestésicos locais |
spellingShingle |
Raquianestesia contínua com altas doses de anestésicos locais Imbelloni, Luiz Eduardo Anesthesic Local: bupivacaine, lidocaine Anesthesic technique Regional: continuous spinal anesthesia Surgery Abdominal: herniorrhaphy Anestésico Local: bupivacaína, lidocaína Cirurgia Abdominal: herniorrafia Técnicas anetésicas Regional: raquianestesia contínua |
title_short |
Raquianestesia contínua com altas doses de anestésicos locais |
title_full |
Raquianestesia contínua com altas doses de anestésicos locais |
title_fullStr |
Raquianestesia contínua com altas doses de anestésicos locais |
title_full_unstemmed |
Raquianestesia contínua com altas doses de anestésicos locais |
title_sort |
Raquianestesia contínua com altas doses de anestésicos locais |
author |
Imbelloni, Luiz Eduardo |
author_facet |
Imbelloni, Luiz Eduardo Gasparini Neto, Savino Ganem, Eliana Marisa [UNESP] |
author_role |
author |
author2 |
Gasparini Neto, Savino Ganem, Eliana Marisa [UNESP] |
author2_role |
author author |
dc.contributor.none.fl_str_mv |
Universidade Estadual Paulista (Unesp) |
dc.contributor.author.fl_str_mv |
Imbelloni, Luiz Eduardo Gasparini Neto, Savino Ganem, Eliana Marisa [UNESP] |
dc.subject.por.fl_str_mv |
Anesthesic Local: bupivacaine, lidocaine Anesthesic technique Regional: continuous spinal anesthesia Surgery Abdominal: herniorrhaphy Anestésico Local: bupivacaína, lidocaína Cirurgia Abdominal: herniorrafia Técnicas anetésicas Regional: raquianestesia contínua |
topic |
Anesthesic Local: bupivacaine, lidocaine Anesthesic technique Regional: continuous spinal anesthesia Surgery Abdominal: herniorrhaphy Anestésico Local: bupivacaína, lidocaína Cirurgia Abdominal: herniorrafia Técnicas anetésicas Regional: raquianestesia contínua |
description |
Background and objectives: Better control of the level, intensity, and duration of spinal analgesia represents the greatest advantages of continuous spinal anesthesia. With the advent of intermediate catheters (over-the-needle catheter) and its low incidence of headaches and neurological symptoms, the technique has been gaining credibility. The objective of this paper is to report the possible safety of the new catheter with a large dose of hyperbaric 0.5% bupivacaine with 1.6% glucose associated with hyperbaric 2% lidocaine with 1.6% glucose. Case Report: Male patient, 78 years old, 85 kg, 168 cm, physical status ASA III, with hypertension, coronary artery disease, and chronic renal failure. The patient was candidate for surgery for huge bilateral inguinal and umbilical hernias, being submitted to preoperative pneumoperitoneum for one week to stretch abdominal cavity. After venoclysis with an 18G catheter, he was monitored with cardioscope, non-invasive blood pressure, and pulse oximetry; he was sedated with 1 mg of midazolam and 100 µg of fentanyl intravenously, and placed in left lateral decubitus. He underwent continuous spinal anesthesia by a median puncture in L3-L4 with a set with a 27G cut-bevel needle and 22G catheter. The total dose of anesthetic used was 25 mg of 0.5% bupivacaine (hyperbaric, with 1.6% glucose), 160 mg of 2% lidocaine (hyperbaric, with 1.6% glucose), and morphine (100 µg). The patient was followed-up until the 30th postoperative day without neurological complaints. Conclusions: Recently, the poor distribution of the local anesthetic through the microcatheter was attributed as the cause of cauda equina syndrome. This case report showed that, with the administration of high doses of hyperbaric anesthetics through the new catheter, poor distribution or risk of cauda equina syndrome were not observed. |
publishDate |
2010 |
dc.date.none.fl_str_mv |
2010 2016-07-07T12:33:20Z 2016-07-07T12:33:20Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://dx.doi.org/10.1590/S0034-70942010000500010 Revista Brasileira de Anestesiologia, v. 60, n. 5, p. 537-543, 2010. 0034-7094 http://hdl.handle.net/11449/140328 10.1590/S0034-70942010000500010 S0034-70942010000500010 S0034-70942010000500010-pt.pdf S0034-70942010000500010-en.pdf 8226942130768820 8226942130768820 8226942130768820 |
url |
http://dx.doi.org/10.1590/S0034-70942010000500010 http://hdl.handle.net/11449/140328 |
identifier_str_mv |
Revista Brasileira de Anestesiologia, v. 60, n. 5, p. 537-543, 2010. 0034-7094 10.1590/S0034-70942010000500010 S0034-70942010000500010 S0034-70942010000500010-pt.pdf S0034-70942010000500010-en.pdf 8226942130768820 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
Revista Brasileira de Anestesiologia 0.850 0,320 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
537-543 application/pdf application/pdf |
dc.source.none.fl_str_mv |
Currículo Lattes reponame:Repositório Institucional da UNESP instname:Universidade Estadual Paulista (UNESP) instacron:UNESP |
instname_str |
Universidade Estadual Paulista (UNESP) |
instacron_str |
UNESP |
institution |
UNESP |
reponame_str |
Repositório Institucional da UNESP |
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Repositório Institucional da UNESP |
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Repositório Institucional da UNESP - Universidade Estadual Paulista (UNESP) |
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1803650164318011392 |