Edno Magalhães

Ephedrine versus phenylephrine: prevention of hypotension during spinal block for cesarean section and effects on the fetus

JUSTIFICATIVA E OBJETIVOS: A hipotensao arterial durante a anestesia raquidea para cesariana deve-se ao bloqueio simpatico e compressao aorto-cava pelo utero e pode ocasionar efeitos deleterios para o feto e a mae. A efedrina e fenilefrina melhoram o retorno venoso apos bloqueio simpatico durante anestesia raquidea. O objetivo deste estudo foi comparar a eficacia da efedrina e da fenilefrina em prevenir e tratar a hipotensao arterial materna durante anestesia raquidea e avaliar seus efeitos colaterais e alteracoes fetais. METODO: Sessenta pacientes, submetidas a anestesia raquidea com bupivacaina e sufentanil para cesariana, foram divididas aleatoriamente em dois grupos para receber, profilaticamente, efedrina (Grupo E, n = 30, dose = 10 mg) ou fenilefrina (Grupo F, n = 30, dose = 80 µg). Hipotensao arterial (pressao arterial menor ou igual a 80% da medida basal) foi tratada com bolus de vasoconstritor com 50% da dose inicial. Foram avaliados: incidencia de hipotensao arterial, hipertensao arterial reativa, bradicardia e vomitos, escore de Apgar no primeiro e quinto minutos e gasometria do cordao umbilical. RESULTADOS: A dose media de efedrina foi 14,8 ± 3,8 mg e 186,7 ± 52,9 µg de fenilefrina. Os grupos foram semelhantes quanto aos parâmetros demograficos e incidencia de vomitos, bradicardia e hipertensao arterial reativa. A incidencia de hipotensao arterial foi de 70% no Grupo E e 93% no Grupo F (p < 0,05). O pH arterial medio do cordao umbilical e o escore de Apgar no primeiro minuto foram menores no grupo E (p < 0,05). Nao houve diferenca no escore do quito minuto. CONCLUSOES: A efedrina foi mais eficiente que fenilefrina na prevencao de hipotensao arterial. Ambos os farmacos apresentaram incidencia semelhante de efeitos colaterais. As repercussoes fetais foram menos frequentes com o uso da fenilefrina e apenas transitorias com a utilizacao da efedrina.

Avaliação da influência do polimorfismo do códon 16 do receptor beta-2 adrenérgico na incidência de hipotensão arterial e uso de efedrina em grávidas submetidas à anestesia subaracnoidea

JUSTIFICATIVA Y OBJETIVOS: El gen del receptor beta-2 adrenergico posee diversos polimorfismos. Estudios recientes han venido demostrando su importancia clinica. El objetivo de este trabajo, fue evaluar la influencia del polimorfismo Arg16Gli en la incidencia de hipotension arterial y el uso de efedrina en parturientas sometidas al bloqueo subaracnoideo para cesarea. METODO: Parturientas sanas (ASA I y II) fueron sometidas a la anestesia raquidea para la realizacion de cesarea electiva (n = 50). Efedrina fue administrada en los casos de hipotension arterial. La incidencia de hipotension arterial y la dosis requerida de efedrina para la correccion de la presion arterial fueron comparadas entre los diferentes genotipos encontrados. RESULTADOS: El genotipo que mas prevalecio fue el Arg16Gli (60%, n = 30) seguido por el Gli16Gli (26%, n = 13) y Arg16Arg (14%, n = 7). No se observaron diferencias entre las caracteristicas basicas de los genotipos. Con relacion al genotipo Arg16Arg, el genotipo Gli16Gli presento un aumento de la razon de riesgo de hipotension arterial (hazard ratio) de 3,95 veces (IC 95% 0,86-18,11; p = 0,076), mientras que el genotipo Arg16Gli presento un aumento de 4,83 veces (IC 95% 1,13-20,50; p = 0,033). Las parturientas con genotipo Arg16Arg, necesitaron como promedio 6,4 ± 8,5 mg de efedrina para la correccion de la hipotension arterial, mientras que las del genotipo Arg16Gli necesitaron 19,5 ± 15,9 mg (p = 0,0445; IC 95% 0.3325-25.78) y las del tipo Gli16Gli 19,2 ± 14,3 (p = 0,0445, IC 95% 0.3476-25.26). CONCLUSIONES: Los resultados mostraron que la variante genetica Arg16Arg presenta una menor incidencia de hipotension arterial y que menores dosis de efedrina fueron necesarias para el reestablecimiento de la normotension arterial en las pacientes con ese perfil genetico. Concluimos que el genotipo Arg16Arg le da una mayor estabilidad de presion a las parturientas sometidas a la anestesia raquidea para cesarea.

Evaluation of the Influence of the Codon 16 Polymorphism of the Beta-2 Adrenergic Receptor Gene on the Incidence of Arterial Hypotension and Ephedrine Use in Pregnant Patients Submitted to Subarachnoid Anesthesia

BACKGROUND AND OBJECTIVES The beta-2 adrenergic receptor gene has several polymorphisms. Recent studies have demonstrated the clinical importance of the latter. The objective of the present study was to evaluate the influence of the Arg16Gli polymorphism on the incidence of arterial hypotension and ephedrine use in pregnant patients submitted to subarachnoid block for Cesarean section. METHOD Healthy parturients (ASA I and II) were submitted to subarachnoid anesthesia for elective Cesarean section (n = 50). Ephedrine was administered in cases of arterial hypotension. The incidence of arterial hypotension and the required dose of ephedrine to correct the arterial pressure were compared between the different genotypes identified. RESULTS The most prevalent genotype was Arg16Gli (60%, n = 30) followed by Gli16Gli (26%, n = 13) and Arg16Arg (14%, n = 7). No differences were observed regarding the basic characteristics of the genotypes. In comparison to the Arg16Arg genotype, the Gli16Gli presented a 3.95-fold increase in the hazard ratio of arterial hypotension (95%CI 0.86-18.11; p = 0.076), whereas the Arg16Gli presented a 4.83-fold increase (95%CI 1.13-20.50; p = 0.033). The parturients with the Arg16Arg needed, on average, 6.4 +/- 8.5 mg of ephedrine to correct the arterial hypotension, whereas those with the Arg16Gli needed 19.5 +/- 15.9 mg (p = 0.0445; 95%CI 0.3325-25.78) and the ones with the Gli16Gli genotype, 19.2 +/- 14.3 (p = 0.0445, 95%CI 0.3476-25.26). CONCLUSIONS The results show that the genetic variant Arg16Arg presents a lower incidence of arterial hypertension and that lower doses of ephedrine were necessary to reestablish normal arterial pressure in the patients with this genetic profile. We conclude that the Arg16Arg genotype confers better pressure stability to the parturients submitted to subarachnoid anesthesia for Cesarean section.

Anesthesia in Patient with Shrinking Lung Syndrome: Case Report

BACKGROUND AND OBJECTIVES The incidence of pulmonary involvement in systemic lupus erythematosus (SLE) may be presented as a syndrome called shrinking lung syndrome (SLS). SLS has quite a controversial pathophysiology, which can induce to a mechanical ventilation dependency. Due to its rarity, there is a limited number of publications on the subject. The objective of this report is to present the case of a patient with SLS who underwent incisional hernia repair under epidural anesthesia. CASE REPORT Female patient with SLE, hypertensive and obese, diagnosed with SLS 18 years ago. She was dependent on nocturnal oxygen at home, had dyspnea on minimal exertion and spirometry with severe restrictive ventilatory defect. In a previous post-operative period under general anesthesia, she remained on mechanical ventilation for 9 days with difficult weaning. She underwent incisional hernia repair for 3 hours under thoracic epidural anesthesia without any pre- or post-operative respiratory complication. CONCLUSIONS Shrinking lung syndrome is a rare disease that requires a prior knowledge of the clinical and laboratory history of the patient by the anesthesiologist. The thoracic epidural anesthesia technique proved to be a satisfactory option for this patient, with highly satisfactory respiratory evolution.

Intravenous dexmedetomidine for sedation does not interfere with sensory and motor block duration during spinal anesthesia

BACKGROUND AND OBJECTIVES The association among local and regional anesthesia is a very useful and common practice. However, some patients may become anxious and require sedation. Benzodiazepines, opioids and propofol are widely used for this aim. Alpha2-adrenergic agonists have hypnotic and sedative properties and represent an alternative to promote hemodynamic stability and minor respiratory depression. This study aimed at evaluating the safety and the interference of intravenous dexmedetomidine or midazolam on sensory and motor block duration spinal anesthesia. METHODS Thirty five adult female patients, physical status ASA I and II, were submitted to spinal anesthesia with hyperbaric 0.5% bupivacaine (15 mg) for elective gynecologic surgery. The patients were randomized and distributed in two groups: Group M (n = 17) - sedation with 0.25 microg.kg-1.min-1 midazolam continuous infusion and Group D (n = 18) sedation with 0.5 microg.kg-1.min-1 dexmedetomidine continuous infusion. Infusion rate was adjusted to maintain BIS between 60 and 80. The following parameters were evaluated: SBP, DBP, HR, SpO2, BIS sensory and motor block extension and duration (Bromage scale). RESULTS There were no statistically significant differences between groups in age, weight, sensory block level, blood pressure and heart rate variation and sensory and motor block duration. CONCLUSIONS Intravenous dexmedetomidine for sedation has not interfered with hemodynamic parameters, spinal anesthesia sensory and motor block duration or extension and it is a good option for sedation during local/regional anesthesia.JUSTIFICATIVA E OBJETIVOS: A anestesia locorregional e uma pratica frequente e de grande aplicabilidade em Anestesiologia. Contudo, o paciente pode tornar-se ansioso, fazendo-se necessaria a sedacao. Os agentes benzodiazepinicos, opioides e o propofol sao amplamente utilizados com este objetivo. Os agonistas alfa2-adrenergicos possuem propriedades hipnoticas e sedativas e sao uma alternativa no arsenal terapeutico, conferindo estabilidade hemodinâmica e minima depressao respiratoria. O objetivo deste estudo foi avaliar a seguranca e a interferencia do uso da dexmedetomidina ou do midazolam, por via venosa, na duracao dos bloqueios motor e sensitivo em raquianestesia. METODO: Foram estudadas 35 pacientes adultas, do sexo feminino, estado fisico ASA I e II, submetidas a raquianestesia com bupivacaina a 0,5% hiperbarica (15 mg), para cirurgia ginecologica eletiva, distribuidas de modo aleatorio em dois grupos: grupo M (n = 17) - sedacao com midazolam em infusao continua a 0,25 µg.kg-1.min-1 e grupo D (n = 18) - sedacao com dexmedetomidina em infusao continua a 0,5 µg.kg-1.min-1. A velocidade de infusao foi ajustada para manter o valor de BIS entre 60 e 80. Foram analisados os valores de PAS, PAD, FC, SpO2, BIS, extensao e duracao dos bloqueios sensitivo motor (escala de Bromage). RESULTADOS: Nao houve diferenca estatistica significativa entre os grupos quanto a idade, peso, nivel de bloqueio sensitivo, variacao na pressao arterial e frequencia cardiaca e na duracao dos bloqueios sensitivo e motor. CONCLUSOES: A dexmedetomidina utilizada em sedacao, por via venosa, nao interferiu nos parâmetros hemodinâmicos, duracao ou extensao dos bloqueios sensitivo e motor na raquianestesia, representando boa opcao para sedacao durante anestesia locorregional.

[Hematoma after epidural anesthesia: conservative treatment. Case report.].

BACKGROUND AND OBJECTIVES Hematoma associated with spinal compression after epidural anesthesia is a severe neurological complication, despite the reduced incidence reported (1:150,000). It is an acute episode and the traditional treatment includes urgent surgical decompression. More recently, treatment with corticosteroids has been used as an alternative, in specific cases, with good neurological resolution. The objective of this report was to present the case of an epidural hematoma treated conservatively with complete neurological recovery. CASE REPORT Female patient, 34 years old, ASA physical status I, with no prior history of bleeding disorders or anticlotting treatment, underwent epidural anesthesia at the L2-L3 level for the surgical treatment of lower limb varicose veins. Eight hours after the regional anesthesia, the patient still presented complete motor blockade (Bromage scale), reduction of thermal and pain sensitivity below L3, hyperalgesia in the left plantar region, preserved tendon reflexes, and absence of lumbar pain. A CT scan showed an epidural hematoma in L2, with compression of the dural sac. Ten hours after the epidural puncture, there was no regression of neurological signs and symptoms. It was decided, then, to treat the patient with a continuous infusion of methylprednisolone (5.3 mg.kg-1 in the first hour and 1.4 mg.kg-1.h-1 in the following 23 hours). Eight hours after the beginning of the treatment, the patient recovered thermal and pain sensitivity and presented total regression of the motor blockade. On the 12th hour, she was walking and complained of pain in the surgical wound. The epidural hematoma was not visualized in a CT scan done 14 hours after the beginning of the treatment. The patient was discharged 86 hours after the beginning of the treatment without neurological deficits. A CT scan done after 7 months showed a completely normal spinal canal. CONCLUSIONS The efficacy of the conservative approach demonstrated that it is an important alternative to surgery in specific cases. The evaluation of the progression or stabilization of the neurological deficit, especially 8 hours after the epidural puncture, is essential in choosing the treatment.JUSTIFICATIVA Y OBJETIVOS: O hematoma asociado a la compresion espinal despues de la anestesia peridural es una complicacion neurologica grave, a pesar de la pequena incidencia relatada (1:150.000). Es un episodio agudo y el tratamiento tradicionalmente aplicado es la descompresion quirurgica de urgencia. Recientemente, en casos especificos, el tratamiento con corticosteroide ha sido aplicado como alternativa y con una buena recuperacion neurologica. El objetivo de este relato fue exponer un caso de hematoma peridural con tratamiento conservador y recuperacion neurologica completa. RELATO DEL CASO: Paciente del sexo femenino, 34 anos, estado fisico ASA I, sin ningun historial de coagulopatia o terapia anticoagulante, sometida a la anestesia peridural con puncion unica, en L2-L3, para tratamiento quirurgico de varices en los miembros inferiores. Ocho horas despues de la anestesia regional, todavia presentaba bloqueo motor completo (escala de Bromage), reduccion de las sensibilidades termica y dolorosa por debajo del nivel L3, hiperalgesia en la region plantar izquierda, preservacion de los reflejos tendinosos y ausencia de dolor lumbar. La tomografia computadorizada revelo hematoma peridural en L2 con compresion del saco dural. Diez horas despues de la puncion peridural no habia progresion de las senales y sintomas neurologicos. Se opto entonces por el tratamiento con metilprednisolona en infusion venosa continua (5,3 mg.kg-1 en la primera hora y 1,4 mg.kg-1.h-1 en las 23 horas siguientes). Ocho horas despues del inicio del tratamiento, la paciente recupero las sensibilidades termica y dolorosa y la regresion total del bloqueo motor. En la 12a hora, deambulaba y referia dolor en la herida operada. El hematoma peridural no se visualizo en una nueva tomografia computadorizada en la 14a hora despues del inicio del tratamiento. La paciente recibio alta hospitalaria 86 horas despues del inicio del tratamiento conservador, sin comprometimiento neurologico. Una tomografia computadorizada de control despues de 7 meses, mostro el canal vertebral completamente normal. CONCLUSIONES: La eficiencia del abordaje conservadora fue una alternativa importante para la intervencion quirurgica en casos especificos. La evaluacion de la progresion o estabilizacion del comprometimiento neurologico, particularmente despues de la 8a hora posterior a la puncion peridural, es esencial para la eleccion del tratamiento.

Hematoma após anestesia peridural: tratamento conservador. Relato de caso

BACKGROUND AND OBJECTIVES Hematoma associated with spinal compression after epidural anesthesia is a severe neurological complication, despite the reduced incidence reported (1:150,000). It is an acute episode and the traditional treatment includes urgent surgical decompression. More recently, treatment with corticosteroids has been used as an alternative, in specific cases, with good neurological resolution. The objective of this report was to present the case of an epidural hematoma treated conservatively with complete neurological recovery. CASE REPORT Female patient, 34 years old, ASA physical status I, with no prior history of bleeding disorders or anticlotting treatment, underwent epidural anesthesia at the L2-L3 level for the surgical treatment of lower limb varicose veins. Eight hours after the regional anesthesia, the patient still presented complete motor blockade (Bromage scale), reduction of thermal and pain sensitivity below L3, hyperalgesia in the left plantar region, preserved tendon reflexes, and absence of lumbar pain. A CT scan showed an epidural hematoma in L2, with compression of the dural sac. Ten hours after the epidural puncture, there was no regression of neurological signs and symptoms. It was decided, then, to treat the patient with a continuous infusion of methylprednisolone (5.3 mg.kg-1 in the first hour and 1.4 mg.kg-1.h-1 in the following 23 hours). Eight hours after the beginning of the treatment, the patient recovered thermal and pain sensitivity and presented total regression of the motor blockade. On the 12th hour, she was walking and complained of pain in the surgical wound. The epidural hematoma was not visualized in a CT scan done 14 hours after the beginning of the treatment. The patient was discharged 86 hours after the beginning of the treatment without neurological deficits. A CT scan done after 7 months showed a completely normal spinal canal. CONCLUSIONS The efficacy of the conservative approach demonstrated that it is an important alternative to surgery in specific cases. The evaluation of the progression or stabilization of the neurological deficit, especially 8 hours after the epidural puncture, is essential in choosing the treatment.JUSTIFICATIVA Y OBJETIVOS: O hematoma asociado a la compresion espinal despues de la anestesia peridural es una complicacion neurologica grave, a pesar de la pequena incidencia relatada (1:150.000). Es un episodio agudo y el tratamiento tradicionalmente aplicado es la descompresion quirurgica de urgencia. Recientemente, en casos especificos, el tratamiento con corticosteroide ha sido aplicado como alternativa y con una buena recuperacion neurologica. El objetivo de este relato fue exponer un caso de hematoma peridural con tratamiento conservador y recuperacion neurologica completa. RELATO DEL CASO: Paciente del sexo femenino, 34 anos, estado fisico ASA I, sin ningun historial de coagulopatia o terapia anticoagulante, sometida a la anestesia peridural con puncion unica, en L2-L3, para tratamiento quirurgico de varices en los miembros inferiores. Ocho horas despues de la anestesia regional, todavia presentaba bloqueo motor completo (escala de Bromage), reduccion de las sensibilidades termica y dolorosa por debajo del nivel L3, hiperalgesia en la region plantar izquierda, preservacion de los reflejos tendinosos y ausencia de dolor lumbar. La tomografia computadorizada revelo hematoma peridural en L2 con compresion del saco dural. Diez horas despues de la puncion peridural no habia progresion de las senales y sintomas neurologicos. Se opto entonces por el tratamiento con metilprednisolona en infusion venosa continua (5,3 mg.kg-1 en la primera hora y 1,4 mg.kg-1.h-1 en las 23 horas siguientes). Ocho horas despues del inicio del tratamiento, la paciente recupero las sensibilidades termica y dolorosa y la regresion total del bloqueo motor. En la 12a hora, deambulaba y referia dolor en la herida operada. El hematoma peridural no se visualizo en una nueva tomografia computadorizada en la 14a hora despues del inicio del tratamiento. La paciente recibio alta hospitalaria 86 horas despues del inicio del tratamiento conservador, sin comprometimiento neurologico. Una tomografia computadorizada de control despues de 7 meses, mostro el canal vertebral completamente normal. CONCLUSIONES: La eficiencia del abordaje conservadora fue una alternativa importante para la intervencion quirurgica en casos especificos. La evaluacion de la progresion o estabilizacion del comprometimiento neurologico, particularmente despues de la 8a hora posterior a la puncion peridural, es esencial para la eleccion del tratamiento.

Anestesia no paciente com síndrome do pulmão encolhido: relato de caso

JUSTIFICATIVA Y OBJETIVOS: La aparicion de la afectacion pulmonar en el Lupus Eritematoso Sistemico (LES), puede aparecer como un sindrome denominado: Sindrome del Pulmon Encogido (SPE). De fisiopatologia bastante controvertida, la SPE puede inducir a la dependencia de la ventilacion mecanica. Debido a su raro aparecimiento, el numero de publicaciones es muy pequeno. El objetivo de este relato, es presentar el caso de un paciente con SPE, sometida a la correccion de hernia incisional bajo anestesia epidural toracica. RELATO DEL CASO: Paciente hipertensa, obesa y portadora de LES, diagnosticada con SPE hace 18 anos. Dependiente de oxigeno domiciliario nocturno, presentaba disnea a los pequenos esfuerzos y espirometria con disturbio ventilatorio restrictivo grave. En el postoperatorio anterior bajo anestesia general, permanecio en ventilacion mecanica por nueve dias con destete dificil. Fue sometida a la correccion de hernia incisional durante tres horas bajo anestesia epidural toracica, sin ninguna complicacion respiratoria per o postoperatoria. CONCLUSIONES: El Sindrome del Pulmon Encogido es una enfermedad rara que exige del anestesiologo tener conocimientos previos, clinicos y laboratoriales sobre el paciente. La tecnica de anestesia epidural toracica ha sido una opcion anestesica satisfactoria para esa paciente, con una evolucion respiratoria altamente satisfactoria.

Hematoma posterior a la anestesia peridural: tratamiento conservador. Relato de caso

BACKGROUND AND OBJECTIVES Hematoma associated with spinal compression after epidural anesthesia is a severe neurological complication, despite the reduced incidence reported (1:150,000). It is an acute episode and the traditional treatment includes urgent surgical decompression. More recently, treatment with corticosteroids has been used as an alternative, in specific cases, with good neurological resolution. The objective of this report was to present the case of an epidural hematoma treated conservatively with complete neurological recovery. CASE REPORT Female patient, 34 years old, ASA physical status I, with no prior history of bleeding disorders or anticlotting treatment, underwent epidural anesthesia at the L2-L3 level for the surgical treatment of lower limb varicose veins. Eight hours after the regional anesthesia, the patient still presented complete motor blockade (Bromage scale), reduction of thermal and pain sensitivity below L3, hyperalgesia in the left plantar region, preserved tendon reflexes, and absence of lumbar pain. A CT scan showed an epidural hematoma in L2, with compression of the dural sac. Ten hours after the epidural puncture, there was no regression of neurological signs and symptoms. It was decided, then, to treat the patient with a continuous infusion of methylprednisolone (5.3 mg.kg-1 in the first hour and 1.4 mg.kg-1.h-1 in the following 23 hours). Eight hours after the beginning of the treatment, the patient recovered thermal and pain sensitivity and presented total regression of the motor blockade. On the 12th hour, she was walking and complained of pain in the surgical wound. The epidural hematoma was not visualized in a CT scan done 14 hours after the beginning of the treatment. The patient was discharged 86 hours after the beginning of the treatment without neurological deficits. A CT scan done after 7 months showed a completely normal spinal canal. CONCLUSIONS The efficacy of the conservative approach demonstrated that it is an important alternative to surgery in specific cases. The evaluation of the progression or stabilization of the neurological deficit, especially 8 hours after the epidural puncture, is essential in choosing the treatment.JUSTIFICATIVA Y OBJETIVOS: O hematoma asociado a la compresion espinal despues de la anestesia peridural es una complicacion neurologica grave, a pesar de la pequena incidencia relatada (1:150.000). Es un episodio agudo y el tratamiento tradicionalmente aplicado es la descompresion quirurgica de urgencia. Recientemente, en casos especificos, el tratamiento con corticosteroide ha sido aplicado como alternativa y con una buena recuperacion neurologica. El objetivo de este relato fue exponer un caso de hematoma peridural con tratamiento conservador y recuperacion neurologica completa. RELATO DEL CASO: Paciente del sexo femenino, 34 anos, estado fisico ASA I, sin ningun historial de coagulopatia o terapia anticoagulante, sometida a la anestesia peridural con puncion unica, en L2-L3, para tratamiento quirurgico de varices en los miembros inferiores. Ocho horas despues de la anestesia regional, todavia presentaba bloqueo motor completo (escala de Bromage), reduccion de las sensibilidades termica y dolorosa por debajo del nivel L3, hiperalgesia en la region plantar izquierda, preservacion de los reflejos tendinosos y ausencia de dolor lumbar. La tomografia computadorizada revelo hematoma peridural en L2 con compresion del saco dural. Diez horas despues de la puncion peridural no habia progresion de las senales y sintomas neurologicos. Se opto entonces por el tratamiento con metilprednisolona en infusion venosa continua (5,3 mg.kg-1 en la primera hora y 1,4 mg.kg-1.h-1 en las 23 horas siguientes). Ocho horas despues del inicio del tratamiento, la paciente recupero las sensibilidades termica y dolorosa y la regresion total del bloqueo motor. En la 12a hora, deambulaba y referia dolor en la herida operada. El hematoma peridural no se visualizo en una nueva tomografia computadorizada en la 14a hora despues del inicio del tratamiento. La paciente recibio alta hospitalaria 86 horas despues del inicio del tratamiento conservador, sin comprometimiento neurologico. Una tomografia computadorizada de control despues de 7 meses, mostro el canal vertebral completamente normal. CONCLUSIONES: La eficiencia del abordaje conservadora fue una alternativa importante para la intervencion quirurgica en casos especificos. La evaluacion de la progresion o estabilizacion del comprometimiento neurologico, particularmente despues de la 8a hora posterior a la puncion peridural, es esencial para la eleccion del tratamiento.

La dexmedetomidina para sedación, por vía venosa, no interfiere con la duración del bloqueo sensitivo y motor de la raquianestesia

BACKGROUND AND OBJECTIVES The association among local and regional anesthesia is a very useful and common practice. However, some patients may become anxious and require sedation. Benzodiazepines, opioids and propofol are widely used for this aim. Alpha2-adrenergic agonists have hypnotic and sedative properties and represent an alternative to promote hemodynamic stability and minor respiratory depression. This study aimed at evaluating the safety and the interference of intravenous dexmedetomidine or midazolam on sensory and motor block duration spinal anesthesia. METHODS Thirty five adult female patients, physical status ASA I and II, were submitted to spinal anesthesia with hyperbaric 0.5% bupivacaine (15 mg) for elective gynecologic surgery. The patients were randomized and distributed in two groups: Group M (n = 17) - sedation with 0.25 microg.kg-1.min-1 midazolam continuous infusion and Group D (n = 18) sedation with 0.5 microg.kg-1.min-1 dexmedetomidine continuous infusion. Infusion rate was adjusted to maintain BIS between 60 and 80. The following parameters were evaluated: SBP, DBP, HR, SpO2, BIS sensory and motor block extension and duration (Bromage scale). RESULTS There were no statistically significant differences between groups in age, weight, sensory block level, blood pressure and heart rate variation and sensory and motor block duration. CONCLUSIONS Intravenous dexmedetomidine for sedation has not interfered with hemodynamic parameters, spinal anesthesia sensory and motor block duration or extension and it is a good option for sedation during local/regional anesthesia.JUSTIFICATIVA E OBJETIVOS: A anestesia locorregional e uma pratica frequente e de grande aplicabilidade em Anestesiologia. Contudo, o paciente pode tornar-se ansioso, fazendo-se necessaria a sedacao. Os agentes benzodiazepinicos, opioides e o propofol sao amplamente utilizados com este objetivo. Os agonistas alfa2-adrenergicos possuem propriedades hipnoticas e sedativas e sao uma alternativa no arsenal terapeutico, conferindo estabilidade hemodinâmica e minima depressao respiratoria. O objetivo deste estudo foi avaliar a seguranca e a interferencia do uso da dexmedetomidina ou do midazolam, por via venosa, na duracao dos bloqueios motor e sensitivo em raquianestesia. METODO: Foram estudadas 35 pacientes adultas, do sexo feminino, estado fisico ASA I e II, submetidas a raquianestesia com bupivacaina a 0,5% hiperbarica (15 mg), para cirurgia ginecologica eletiva, distribuidas de modo aleatorio em dois grupos: grupo M (n = 17) - sedacao com midazolam em infusao continua a 0,25 µg.kg-1.min-1 e grupo D (n = 18) - sedacao com dexmedetomidina em infusao continua a 0,5 µg.kg-1.min-1. A velocidade de infusao foi ajustada para manter o valor de BIS entre 60 e 80. Foram analisados os valores de PAS, PAD, FC, SpO2, BIS, extensao e duracao dos bloqueios sensitivo motor (escala de Bromage). RESULTADOS: Nao houve diferenca estatistica significativa entre os grupos quanto a idade, peso, nivel de bloqueio sensitivo, variacao na pressao arterial e frequencia cardiaca e na duracao dos bloqueios sensitivo e motor. CONCLUSOES: A dexmedetomidina utilizada em sedacao, por via venosa, nao interferiu nos parâmetros hemodinâmicos, duracao ou extensao dos bloqueios sensitivo e motor na raquianestesia, representando boa opcao para sedacao durante anestesia locorregional.