Roberto Taboada Fellini

Anestesia para cesariana em paciente com síndrome de Guillain-Barré: relato de caso

BACKGROUND AND OBJECTIVES Guillain-Barre syndrome during pregnancy is considered a rare neurological complication, and there is no consensus in literature for anesthetic management for cesarean section in such patients. The objective of this paper is to report the case of a pregnant woman with Guillain-Barre syndrome undergoing cesarean section. CASE REPORT Female patient, 22-year old, 35 weeks and 5 days of gestation, undergoing cesarean section, hospitalized, reporting decreased strength and lower limb paresthesias. Cerebrospinal fluid (CSF) analysis showed increased protein (304 mg.dL-1) without increased cellularity. The anesthetic technique used was general anesthesia induced with propofol (1.5 mg.kg-1) and maintained with 2% sevoflurane in oxygen and fentanyl (3 μg.kg⁻¹). The procedure was uneventful for both mother and neonate. The patient was discharged 10 days after admission, after progressive improvement of neurological symptoms. CONCLUSION The anesthetic technique for pregnant women with Guillain-Barre syndrome requiring cesarean section remains at the discretion of the anesthesiologist, who should be guided by the clinical conditions and comorbidities of each patient.

Anesthesia for Cesarean Section in a Patient with Guillain-Barre Syndrome: Case Report

BACKGROUND AND OBJECTIVES Guillain-Barre syndrome during pregnancy is considered a rare neurological complication, and there is no consensus in literature for anesthetic management for cesarean section in such patients. The objective of this paper is to report the case of a pregnant woman with Guillain-Barre syndrome undergoing cesarean section. CASE REPORT Female patient, 22-year old, 35 weeks and 5 days of gestation, undergoing cesarean section, hospitalized, reporting decreased strength and lower limb paresthesias. Cerebrospinal fluid (CSF) analysis showed increased protein (304 mg.dL(-1)) without increased cellularity. The anesthetic technique used was general anesthesia induced with propofol (1.5 mg.kg(-1)) and maintained with 2% sevoflurane in oxygen and fentanyl (3 μg.kg(-1)). The procedure was uneventful for both mother and neonate. The patient was discharged 10 days after admission, after progressive improvement of neurological symptoms. CONCLUSION The anesthetic technique for pregnant women with Guillain-Barre syndrome requiring cesarean section remains at the discretion of the anesthesiologist, who should be guided by the clinical conditions and comorbidities of each patient.

Preparo de cólon para colonoscopia com polietilenoglicol versus sulfato de magnésio em pacientes acima de 70 anos de idade

OBJECTIVES: To compare efficacy and safety of magnesium sulphate in relation to polyethylene glycol in bowel preparation for colonoscopy. METHODS: Sixty patients older than 70 years old, of both genders, were selected for the study, and were randomly divided into two groups: the control group, using polyethylene glycol and the in study group with magnesium sulphate. Quality of preparation, patient tolerance, and side effects produced by each substance were evaluated. Colonoscopist was blinded in relation to the information of bowel preparation. RESULTS: Patients present a homogeneus distribution in groups, in factors as age, past pathologies, side effects, cleansing quality and time taken to reach cecum during colonoscopy. There were differences in gender distribution, being higher the number of female individuals in the group which used magnesium sulphate, however with no statistical significance. CONCLUSION: Magnesium sulphate presented no statistical difference in relation to safety and efficacy levels in patients older than 70 years old, for bowel preparation, when it is compared with polyethylene glycol.

Manejo da via aérea na angina de Ludwig – um desafio: relato de caso

BACKGROUND Ludwigs angina (LA) is an infection of the submandibular space, first described by Wilhelm Frederick von Ludwig in 1836. It represents an entity difficult to manage due to the rapid progression and difficulty in maintaining airway patency, a major challenge in medical practice, resulting in asphyxia and death in 8-10% of patients. OBJECTIVE Describe a case of a patient with Ludwigs angina undergoing surgery, with emphasis on airway management, in addition to reviewing the articles published in the literature on this topic. CASE REPORT Male patient, 21 years, drug addict, admitted by the emergency department and diagnosed with LA. Difficult airway was identified during the anesthetic examination. In additional tests, significant deviation from the tracheal axis was seen. Undergoing bilateral thoracoscopic pleural drainage, we opted for airway management through tracheal intubation using fiberoptic bronchoscopy, and balanced general anesthesia was proposed. There were no complications during the surgical-anesthetic act. After the procedure, the patient remained intubated and mechanically ventilated in the intensive care unit. CONCLUSIONS Airway management in patients with Ludwigs angina remains challenging. The choice of the safest technique should be based on clinical signs, technical conditions available, and the urgent need to preserve the patients life.