Abstract:
BACKGROUND AND OBJECTIVES:Complications of pregnant patients with medullary injury include urinary infection, renal stones, anemia, decubitus ulcers, muscle spasms, sepsis, uterine hyperactivity and autonomic hyperreflexia. Autonomic hyperreflexia is the most severe anesthetic complication and should, before all, be prevented. It is often developed in patients with medullary transection at the level of the 5th to 7th thoracic vertebra or above. This report aims at presenting a case of tetraplegic pregnant patient with injury at the level of the 6th cervical vertebra, submitted to Cesarean section under continuous epidural anesthesia with 0.25% bupivacaine without vasoconstrictor associated to fentanyl. CASE REPORT:Caucasian, tetraplegic primiparous term patient, 39 weeks of gestational age, 22 years old, 63 kg, 168 cm, physical status ASA II, admitted for elective Cesarean section. Patient reported spinomedullary trauma at C6, three years ago. After previous hydration with 1500 ml saline, epidural anesthesia was induced with medial puncture at L3-L4 interspace with the patient in the lateral position, disposable 17G Tuohy needle and without previous local infiltration anesthesia. Immediately after needle insertion, there was adjacent paravertebral muscles contraction, blood pressure increase (BP = 158 x 72 mmHg) and heart rate increase (HR = 90 bpm). Patient, however, did not refer pain. Needle was removed and local anesthesia was induced. Epidural block proceeded with 20 ml of 0.25% bupivacaine without vasoconstrictor associated to 100 microg spinal fentanyl and epidural catheter insertion in the cephalad direction (3 to 4 cm). Surgery went on without intercurrences with no need for blockade complementation. There were two arterial hypotension episodes in the first 24 postoperative hours, which were treated with lactated Ringers solution. Epidural catheter was maintained for 48 hours. Patient was discharged three days after. CONCLUSIONS:For paraplegic or tetraplegic pregnant patients, continuous epidural anesthesia with low local anesthetic concentration without vasoconstrictor and associated to fentanyl is a good indication for instrumented or not vaginal delivery, and Cesarean sections to prevent autonomic hyperreflexia. It is also important that the epidural catheter remains for at least 24 hours after delivery to block sympathetic afference in case a crisis is triggered.
journal_name
Rev Bras Anestesioljournal_title
Revista brasileira de anestesiologiaauthors
Simoni RF,Leite MR,Fófano R,Giancoli M,Cangiani LMdoi
10.1590/s0034-70942003000400007subject
Has Abstractpub_date
2003-08-01 00:00:00pages
481-8issue
4eissn
0034-7094issn
1806-907Xpii
S0034-70942003000400007journal_volume
53pub_type
杂志文章abstract:CONTENT:Malignant hyperthermia (MH) is a potentially lethal pharmacogenetic disorder that affects genetically predisposed individuals. It manifests in susceptible individuals in response to exposure to Inhalant anesthetics, depolarizing muscle relaxants or extreme physical activity in hot environments. During exposure ...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章,评审
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更新日期:2012-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Different oxygenation techniques aim at promoting denitrogenation before apnea during induction. The main reason why CIO2 = 100% cannot be reached is the lack of adequate face mask coupling, allowing the entry of room air. Although anesthesiologists know this principle, not all of them apply i...
journal_title:Revista brasileira de anestesiologia
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更新日期:2005-10-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Peribulbar anesthesia can reduce ocular blood flow (OBF) by increasing intraocular pressure (IOP) or due to the action of drugs. Ropivacaine has low toxicity and intrinsic vasoconstrictive properties, yet to be proven on the ocular vasculature. Measurements of ocular pulse amplitude (OPA) allo...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章,随机对照试验
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更新日期:2010-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Off-pump CABG surgery is related to major and abrupt hemodynamic changes that may not be immediately detected by continuous cardiac output measurement (CCO). This study aimed at comparing results of cardiac index measurement with pulmonary artery catheter (PAC) with thermal filament (Baxter Ed...
journal_title:Revista brasileira de anestesiologia
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更新日期:2004-06-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Tremors can be an adverse effect of the surgical intervention and anesthesia. The incidence of postoperative tremors varies from 6.3% to 66%. Young age, male gender, the use of halogenated anesthetics, and prolonged anesthesia or surgical procedure are related with tremors. Tremors are involun...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1590/s0034-70942007000400012
更新日期:2007-08-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Human chorionic gonadotropin (HCG) and thyrotrophic hormone (TSH) have analogies in their structures, as well as in their receptors. The high levels of HCG seen in gestational trophoblastic diseases may induce secondary hyperthyroidism. The objective of this report was to present a case in whi...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
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更新日期:2011-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The discontinuation of drugs such as angiotensin-converting enzyme inhibitors (ACE inhibitors) has been suggested based on reports of hypotension during anesthesia. This may imply on a higher risk of intraoperative hypertensive peaks with deleterious consequences for the patient. The objective...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:
更新日期:2009-11-01 00:00:00
abstract:INTRODUCTION:Blood is an important resource in several lifesaving interventions, such as anemia correction and improvement of oxygen transport capacity. Despite advances, packed red blood cell (PRBC) transfusion still involves risks. The aim of this study was to describe the knowledge of anesthesiologists about the ind...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
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更新日期:2017-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Postanesthetic Delirium (PAD) is a common acute mental disorder most commonly developed in elderly patients. Its pathophysiology is poorly understood and PAD is often confused with others psychiatric disorders. This study aimed at reviewing important features of this anesthetic complication in...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1590/s0034-70942002000200013
更新日期:2002-04-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The SAPS 3 (Simplified Acute Physiology Score 3) prognostic system is composed of 20 parameters, represented by an acute physiology score and assessment of the previous status, aimed at establishing a predictive mortality index for patients admitted to intensive care units (ICU). The objective...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:The aim of this study was to investigate the effects of spinal anesthesia using two different doses of fentanyl combined with low-dose levobupivacaine in anorectal surgery. METHODS:In this prospective, double-blind study, 52 American Society of Anaesthesiologists I-II patients scheduled for elective anorect...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1016/j.bjan.2014.01.007
更新日期:2015-11-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethason...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
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更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Several locoregional techniques have been described for the management of acute and chronic pain after breast surgery. The optimal technique should be easy to perform, reproducible, with little discomfort to the patient, little complications, allowing good control of acute pain and a decreased incidence of c...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1016/j.bjan.2015.12.002
更新日期:2016-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Anesthesiologists have traditionally developed and mastered regional anesthetic techniques over the years. To help treating chronic pain, they need to transfer acquired know-how in addition to surgical indications, recommending procedures at the right time in a multidisciplinary approach. This...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1590/s0034-70942003000500013
更新日期:2003-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Temporal cycles (dark/light; birth/death; etc.), along with environmental conditions (synchronizers), influence labor physiology because of the presence of endogenous clocks (oscillators) that interact with social diuturnal clues. In this review, the most important cyclic anesthetic-obstetric ...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章,评审
doi:
更新日期:2009-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Proficiency in ultrasound-guided blocks demands four skills: recognition of the ultrasound anatomy, capacity to generate images, aligning the needle with the ultrasound beam, and recognizing the dispersion of the local anesthetic. The objective of this study was to construct and evaluate learn...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1590/s0034-70942009000200006
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The relationship between altered blood glucose levels and perioperative complications in elderly patients undergoing surgeries are not known. The objective of this study was to evaluate the association between fasting blood glucose levels and perioperative morbimortality in elderly surgical pa...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1590/s0034-70942007000600006
更新日期:2007-12-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:High doses of opioids decrease the hemodynamic response to tracheal intubation. However, the slow recovery profile of traditional opioids may limit the use of high doses. Remifentanil has a fast time of onset and is short acting, which differentiates it from the other drugs in this class. The ...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1590/s0034-70942007000300003
更新日期:2007-06-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Histamine receptors mediate nociceptive pathways, especially in the central nervous system. Some studies have demonstrated the analgesic effects of histamine receptor antagonists in the peripheral nervous system. It is not clear whether the local analgesic effect is class-specific or drug-spec...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1590/s0034-70942009000400008
更新日期:2009-07-01 00:00:00
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journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1016/j.bjan.2014.01.001
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Deep analgesia of burned patients needing daily care of their injuries is a field where references are very scarce in the literature. This study aimed at evaluating balneotherapy anesthetic technique in 2852 procedures. METHODS:A one-year period prospective evaluation was performed on sedativ...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1590/s0034-70942004000200010
更新日期:2004-04-01 00:00:00
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pub_type: 杂志文章
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更新日期:2018-01-01 00:00:00
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journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
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更新日期:2017-01-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The aim of this study was to evaluate the efficacy, postoperative analgesia, the degree of satisfaction of the patients submitted to manual intrauterine aspiration, and whether the patient would recommend the technique, by comparing two anesthetic techniques. METHODS:A prospective study was d...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1590/s0034-70942006000500002
更新日期:2006-10-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Although acute and chronic pain are usually controlled with pharmacological interventions, 14 complementary methods of adjuvant and alternative analgesia (AAA) may reduce the abusive prescription of analgesics and the side effects that eventually compromise the patient's physiological status. ...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1590/s0034-70942006000500012
更新日期:2006-10-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:It is known that acute postoperative pain has a major influence on surgical patients recovery. Early movements, shorter hospital stay, lower costs and higher satisfaction are results of adequate pain management. There is a world trend toward specialized postoperative pain management services. ...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1590/s0034-70942003000600012
更新日期:2003-12-01 00:00:00
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journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1590/s0034-70942002000500010
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND AND OBJECTIVES:The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdomina...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
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更新日期:2017-01-01 00:00:00
abstract::Post-operative pain management is a significant problem in clinical practice in Latin America. Insufficient or inappropriate pain management is in large part due to insufficient knowledge, attitudes and education, and poor communications at various levels. In addition, the lack of awareness of the availability and imp...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
doi:10.1016/j.bjan.2016.04.011
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:Perioperative myocardial ischemia is common among patients undergoing hip fracture surgery. Our aim is to evaluate the efficacy of perioperative continuous lumbar plexus block in reducing the risk of cardiac ischemic events of elderly patients undergoing surgery for hip fractures, expressed as a reduction of...
journal_title:Revista brasileira de anestesiologia
pub_type: 杂志文章
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更新日期:2018-01-01 00:00:00