RESUMO

BACKGROUND AND OBJECTIVES: A combination of epidural and general anesthesia has been widely used to attenuate the surgical stress response and to provide postoperative analgesia. This case report illustrates the use of this anesthetic technique. Analgesia was induced with local anesthetic in the immediate postoperative period using unintentional 19.1% potassium chloride (KCl) as diluent. METHODS: An ASA I male patient was scheduled for surgical correction of idiopathic megaesophagus under continuous epidural anesthesia combined with general anesthesia. In the postoperative period, while preparing 10 mL 0.125% bupivacaine to be administered through the epidural catheter for pain control, 5 mL 19.1% KCl was unintentionally used as diluent, resulting in a 9.55% potassium solution concentration. RESULTS: The patient developed warmness of the lower limbs, tachycardia, hypertension, intense pruritus on the chest, agitation, exacerbation of sensory and motor blocks, and respiratory failure secondary to pulmonary edema, requiring ventilatory support. Total recovery was observed after 24 hours. CONCLUSIONS: Epidurally injected potassium leads to severe clinical manifestations caused by autonomic dysfunction, spinal cord irritation, and possible release of histamine. Despite continuous recommendations, ampule misidentification still happens in hospitals, frequently leading to serious accidents.

Assuntos

Cloreto de Potássio/administração & dosagem , Cloreto de Potássio/efeitos adversos , Prurido/induzido quimicamente , Insuficiência Respiratória/induzido quimicamente , Sistema Nervoso Simpático/efeitos dos fármacos , Sistema Nervoso Simpático/fisiopatologia , Adulto , Anestesia Epidural , Anestesia Geral , Humanos , Injeções Epidurais , Masculino

RESUMO

A method for supporting the porcine valve was devised to approximate more closely the normal porcine anatomy. This mounting technique resulted in a low profile valve with a greater valve orifice and a lower transvalvular gradient than other porcine bioprostheses (Liotta BioImplant L.P.B., BioImplant, Canada, Inc). There were 297 valves implanted in 279 patients operated on from November 1978 through December 1981. Of these, there were 132 aortic valve replacements (AVR), 129 mitral valve replacements (MVR), and 18 double valve replacements (DVR). The actuarial curve at 72 months showed a late patient survival of 78.48% +/- 5.68% for AVR, 86.27% +/- 4.3% for MVR, and 77.78% +/- 12.2% for DVR. Of these, 93.6% of the AVR patients and 81% of the MVR patients remained in the New York Heart Association Class I postoperatively.