RESUMO

BACKGROUND AND OBJECTIVES: Pseudomyxoma peritonei is a rare condition related to epithelial neoplasia of the appendix and ovaries. Surgical cytoreduction, peritonectomy, and hyperthermic intraoperative peritoneal chemotherapy (HIPEC) is the treatment of choice. Maintenance of normovolemia, normothermia, postoperative pain management and coagulation status are all responsibility of the anesthesiologist. The objective of this report was to describe a case of peritonectomy with HIPEC. CASE REPORT: This is a 37 year-old female, ASA I, with a history of appendectomy 3 months ago with an anatomopathological report of mucinous cystoadenoma. After review of the pathological sample, a pseudomyxoma peritonei was diagnosed with indication of peritonectomy with HIPEC. An epidural catheter (T11-T12) was placed and a test-dose, as well as morphine, was administered. Anesthesia was induced with remifentanil, 0.4 µg.kg⁻¹.min⁻¹, propofol, and rocuronium, besides rapid-sequence orotracheal intubation. Remifentanil, sevoflurane, and rocuronium were used for anesthesia maintenance according to the TOF. Ropivacaine 50mg, and fentanyl 10 µg. in 10 mL were administered through the epidural catheter 10 minutes before incision. During the surgery, CVP, SpO2, FeCO2, temperature, heart rate, MAP, and urine output maintained stable levels within normal limits, including during HIPEC. Reduction of the hematocrit and SvO2, increased PT, and thrombocytopenia were corrected by administering blood products. After 13 hours of surgery, the patient was admitted to the ICU under controlled ventilation. She was extubated on the 1(st) postoperative day, being discharged from the hospital on the 17(th) day of hospitalization. CONCLUSIONS: Surgical cytoreduction and peritonectomy with HIPEC goes back to the decade of 1990 with several studies showing a significant increase in survival. Due to the complexity of the procedure and large surgery the vigilance of the anesthesiologist is fundamental for maintenance of clinical and laboratorial parameters, and recognition and treatment of any changes.

Assuntos

RESUMO

BACKGROUND AND OBJECTIVES: Breakage of epidural catheters during their removal is rare, but it has been described. The anesthesiologist should be aware of the complications and proper handling of those catheters. The objective of this report was to present a case of breakage of an epidural catheter in labor analgesia. CASE REPORT: A 33-year old female, gravida II, I delivery, was admitted to the maternity ward in labor. After two hours, the patient requested analgesia. On physical exam, the patient was in labor, with cervical dilation of 5 cm, regular uterine dynamics, broken amniotic membrane, and pain of 10 by the Visual Analog Scale (VAS). Labor analgesia was instituted using combined double puncture technique. During labor evolution, one analgesia complementation through the catheter. Catheter removal was somewhat difficult, leading to breakage of the catheter. Axial CT and X-ray of the lumbar spine did not show the fragment of the catheter. Since the patient was asymptomatic, without signs of radicular irritation, pain, or infection, proper precautions were taken and the patient was discharged from the hospital. CONCLUSIONS: Epidural catheters in the lumbar region are, occasionally, hard to remove. Factors that increase the chances of knot formation and the risk of breakage of catheters were listed. In the present case, one of the main factors was the excessive introduction of the epidural catheter. Luckily, neurologic complications are even less frequent, and applying gentle traction, in the absence of paresthesias, the catheter is usually successfully removed.

Assuntos

RESUMO

BACKGROUND AND OBJECTIVES: Postoperative vomiting is a common and unpleasant complication. Currently, however, mathematical models, such as number necessary to treat (NNT) and relative risk reduction (RRR), have been useful in the decision of which medication to use for prophylaxis. This study aimed at verifying whether dexamethasone, as compared to metoclopramide, decreases the incidence of vomiting when intravenously administered to children anesthetized with sevoflurane for ambulatory pediatric surgeries. METHODS: Two hundred and thirty seven male children, aged 11 months to 12 years, physical status ASA I and II, undergoing hernia repair were included in this study. They were premedicated with oral midazolam. Anesthesia was induced and maintained with sevoflurane, nitrous oxide, and 1 microg kg(-1) fentanyl. Patients were divided in two groups: group D patients (n = 118) were given 150 microg kg(-1) dexamethasone at induction while group M (n = 119) received 150 microg kg(-1) metoclopramide at induction. The following parameters were evaluated: incidence of vomiting in the first 4 postoperative hours (PO), incidence of vomiting between 4 and 24 PO hours, NNT of both medications and RRR of dexamethasone as compared to metoclopramide. RESULTS: The incidence of vomiting was 9.32% for group D and 33.61% for group M during the first 4 PO hours, and 1.69% with dexamethasone and 3.36% with metoclopramide between 4 and 24 PO hours. RRR of dexamethasone related to metoclopramide in the first 4 hours was 72%. The number necessary to treat (NNT) for dexamethasone was 3.25 and for metoclopramide it was 15.66. CONCLUSIONS: Dexamethasone is more effective than metoclopramide in decreasing the incidence of vomiting when used during anesthetic induction with sevoflurane associated to nitrous oxide and fentanyl.