RESUMO
Mitochondrial Myopathy is a rare pathology caused by a defect in the mitochondrial DNA metabolism, leading to defects in the formation of adenosine triphosphate, in the Krebs citric acid cycle, fatty acid oxidation and oxidative phosphorylation. It is manifested by exercise intolerance, muscle fatigue on small efforts, muscle weakness, tachycardia, and difficulty breathing. There are few case reports on the operative management of adult patients suffering from mitochondrial myopathy. With this report, we intend to describe the anesthetic management of a patient with mitochondrial myopathy who underwent laparoscopic gastroplasty and outline some anesthetic considerations about this pathology.
Assuntos
Anestesia , Cirurgia Bariátrica , Miopatias Mitocondriais , Adulto , Humanos , Miopatias Mitocondriais/complicaçõesRESUMO
BACKGROUND AND OBJECTIVES: Surgical trauma, pain and opioids can cause nausea, vomiting, ileus and increased length of hospital stay. The primary objective of the study was to evaluate the time to recovery of gastrointestinal function and the time to meet hospital discharge criteria after laparoscopic bariatric surgery with intraoperative intravenous lidocaine administration. Secondary objectives were to evaluate morphine consumption during the first 24 h and the side effects of opioids. METHODS: Fifty-eight patients aged 18 to 60 years who underwent bariatric surgery were allocated into two groups. Group 1 patients received intravenous lidocaine (1.5 mg/kg) 5 min before induction of anaesthesia, followed by infusion (2 mg/kg/h) until the end of surgery. Group 2 patients were given 0.9% saline solution (placebo) and infusion of 0.9% saline solution during surgery, in same volume as group 1. Anaesthesia was performed with fentanyl (5 µg/kg), propofol (2 mg/kg), rocuronium (0.6 mg/kg) and sevoflurane. Postoperative patient-controlled analgesia was with morphine. There were two groups that were evaluated: time to recovery of gastrointestinal function and time to meet discharge criteria. RESULTS: There was no significant difference between groups regarding the time to first flatus, time to meet discharge criteria and occurrence of side effects. Consumption of intraoperative sevoflurane and morphine over 24 h was significantly lower in the lidocaine group. Side effects observed were nausea and vomiting, with no difference between groups. CONCLUSIONS: Perioperative intravenous lidocaine is feasible and easily accessible when administered at appropriate doses. Lidocaine reduces morphine consumption.
Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Adolescente , Adulto , Analgésicos Opioides/uso terapêutico , Anestésicos Locais/uso terapêutico , Método Duplo-Cego , Hospitais , Humanos , Infusões Intravenosas , Lidocaína/uso terapêutico , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Alta do Paciente , Estudos Prospectivos , Adulto JovemRESUMO
BACKGROUND: Osteoarthrosis is a common cause of low back pain. The diagnosis is clinical and can be confirmed by imaging studies. Pain treatment and confirmation of diagnosis are made by intra-articular injection of corticosteroid and by local anesthetic use, due to clinical improvement. A direct monitoring of the procedure can be done under fluoroscopy, a classic technique, or else by an ultrasound-guided procedure. CASE REPORT: Female patient, 88 years old, 1.68m and 72kg, with facet osteoarthrosis at L2-L3, L3-L4 and L4-L5 for two years. On physical examination, she exhibited pain on lateralization and spinal extension. We opted in favor of an ultrasound-guided facet joint block. A midline spinal longitudinal scan was obtained, with identification of the desired joint space at L3-L4. A 25 G needle was inserted into the skin by the echographic off-plane ultrasound technique. 1 mL of contrast was administered, with confirmation by fluoroscopy. After aspiration of the contrast, 1 mL of solution containing 0.25% bupivacaine hydrochloride and 10 mg of methylprednisolone acetate was injected. Injections into L3-L4, L2-L3 and L1-L2 to the right were applied. CONCLUSIONS: The visualization of the facet joint by ultrasound involves minimal risk, besides reduction of radiation. This option is suitable for a large part of the population. However, fluoroscopy and computed tomography remain as monitoring techniques indicated for patients with specific characteristics, such as obesity, severe degenerative diseases and anatomical malformations, in which the ultrasound technique is still in need of further study.
RESUMO
BACKGROUND: osteoarthrosis is a common cause of low back pain. The diagnosis is clinical and can be confirmed by imaging studies. Pain treatment and confirmation of diagnosis are made by intra-articular injection of corticosteroid and by local anesthetic use, due to clinical improvement. A direct monitoring of the procedure can be done under fluoroscopy, a classic technique, or else by an ultrasound-guided procedure. CASE REPORT: female patient, 88 years old, 1.68 m and 72 kg, with facet osteoarthrosis at L2-L3, L3-L4 and L4-L5 for two years. On physical examination, she exhibited pain on lateralization and spinal extension. We opted in favor of an ultrasound-guided facet joint block. A midline spinal longitudinal scan was obtained, with identification of the desired joint space at L3-L4. A 25G needle was inserted into the skin by the echographic off-plane ultrasound technique. 1 mL of contrast was administered, with confirmation by fluoroscopy. After aspiration of the contrast, 1 mL of solution containing 0.25% bupivacaine hydrochloride and 10mg of methylprednisolone acetate was injected. Injections into L3-L4, L2-L3 and L1-L2 to the right were applied. CONCLUSIONS: the visualization of the facet joint by ultrasound involves minimal risk, besides reduction of radiation. This option is suitable for a large part of the population. However, fluoroscopy and computed tomography remain as monitoring techniques indicated for patients with specific characteristics, such as obesity, severe degenerative diseases and anatomical malformations, in which the ultrasound technique is still in need of further study.
Assuntos
Bupivacaína/administração & dosagem , Dor Lombar/etiologia , Bloqueio Nervoso/métodos , Osteoartrite da Coluna Vertebral/tratamento farmacológico , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Feminino , Fluoroscopia/métodos , Humanos , Dor Lombar/tratamento farmacológico , Metilprednisolona/administração & dosagem , Metilprednisolona/análogos & derivados , Acetato de Metilprednisolona , Osteoartrite da Coluna Vertebral/diagnóstico , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção , Articulação ZigapofisáriaRESUMO
BACKGROUND: Osteoarthrosis is a common cause of low back pain. The diagnosis is clinical and can be confirmed by imaging studies. Pain treatment and confirmation of diagnosis are made by intra-articular injection of corticosteroid and by local anesthetic use, due to clinical improvement. A direct monitoring of the procedure can be done under fluoroscopy, a classic technique, or else by an ultrasound-guided procedure. CASE REPORT: Female patient, 88 years old, 1.68 m and 72 kg, with facet osteoarthrosis at L2-L3, L3-L4 and L4-L5 for two years. On physical examination, she exhibited pain on lateralization and spinal extension. We opted in favor of an ultrasound-guided facet joint block. A midline spinal longitudinal scan was obtained, with identification of the desired joint space at L3-L4. A 25 G needle was inserted into the skin by the echographic off-plane ultrasound technique. 1 mL of contrast was administered, with confirmation by fluoroscopy. After aspiration of the contrast, 1 mL of solution containing 0.25% bupivacaine hydrochloride and 10 mg of methylprednisolone acetate was injected. Injections into L3-L4, L2-L3 and L1-L2 to the right were applied. CONCLUSIONS: The visualization of the facet joint by ultrasound involves minimal risk, besides reduction of radiation. This option is suitable for a large part of the population. However, fluoroscopy and computed tomography remain as monitoring techniques indicated for patients with specific characteristics, such as obesity, severe degenerative diseases and anatomical malformations, in which the ultrasound technique is still in need of further study. .
JUSTIFICATIVA: a osteoartrose facetária é causa frequente de dor lombar. O diagnóstico é clínico e pode ser confirmado por imagem. O tratamento da dor e a confirmação do diagnóstico são feitos pela injeção intra-articular de corticosteroide e anestésico local, por causa da melhoria clínica. A monitoração direta do procedimento pode ser feita por fluoroscopia, técnica clássica, ou guiada por ultrassom. RELATO DE CASO: paciente do sexo feminino, 88 anos, 1,68 m e 72 kg, com osteoartrose facetária em L2-L3, L3-L4 e L4-L5 havia dois anos. No exame físico, dor à lateralização e à extensão da coluna. Optou-se pelo bloqueio da articulação facetária guiado por ultrassom. Foi feito escaneamento longitudinal na linha média da coluna vertebral e identificado o espaço articular desejado em L3-L4. Uma agulha 25G foi introduzida na pele pela técnica fora de plano ecográfico. Foi administrado 1 mL de contraste, confirmado com fluoroscopia. Após aspiração do contraste, foi injetado 1 mL de solução contendo cloridrato de bupivacaína 0,25% e 10 mg de acetato de metilprednisolona. Foram feitas injeções nos espaços L3-L4, L2-L3 e L1-L2 à direita. CONCLUSÕES: a visualização da articulação facetária pelo ultrassom determina mínimo risco e redução da radiação e é indicada para grande parte da população. Ainda assim a fluoroscopia e a tomografia computadorizada permanecem como monitoração indicada para pacientes com características específicas, como obesidade, doenças degenerativas intensas e malformações anatômicas, nas quais o ultrassom ainda necessita de mais estudos. .
JUSTIFICACIÓN: la osteoartrosis facetaria es causa frecuente de dolor lumbar. El diagnóstico es clínico y puede ser confirmado por imagen. El tratamiento del dolor y la confirmación del diagnóstico se hacen mediante la inyección intraarticular de corticosteroides y anestésico local para la mejoría clínica. La monitorización directa del procedimiento puede hacerse por fluoroscopia, técnica clásica, o guiada por ultrasonido. CASO CLÍNICO: paciente del sexo femenino, de 88 años, de 1,68 m y 72 kg, con osteoartrosis facetaria en L2-L3, L3-L4 y L4-L5 hacía ya 2 años. En el examen físico se constató dolor a la lateralización y a la extensión de la columna. Optamos por el bloqueo de la articulación facetaria guiado por ultrasonido. Se hizo un escaneo longitudinal en la línea media de la columna vertebral y se identificó el espacio articular deseado en L3-L4. Una aguja 25G se introdujo en la piel por la técnica fuera del plano ecográfico. Se administró 1 mL de contraste, confirmado con la fluoroscopia. Después de la aspiración del contraste, se inyectó 1 mL de solución conteniendo clorhidrato de bupivacaína al 0,25% y 10 mg de acetato de metilprednisolona. Se administraron inyecciones en los espacios L3-L4, L2-L3 y L1-L2 a la derecha. CONCLUSIONES: la visualización de la articulación facetaria por el ultrasonido determina un mínimo riesgo y una reducción de la radiación y está indicada para gran parte de la población. Pero incluso así, la fluoroscopia y la tomografía computadorizada permanecen como la monitorización indicada para pacientes con características específicas, como obesidad, enfermedades degenerativas intensas y malformaciones anatómicas, para las cuales el ultrasonido todavía necesita más estudios. .