RESUMO
A 33-year-old male patient with multiple sclerosis (MS) received an emergency laparotomy because of perforated appendicitis. He had been suffering from MS for 2 years and the symptoms of MS were paraplegia and urinary incontinence. Anesthesia was induced with propofol and remifentanil and maintained with nitrous oxide, sevoflurane and remifentanil. Rocuronium was used for tracheal intubation. Train of four ratio and bispectral index scale were also monitored for adequate muscle relaxation and anesthetic depth. The patient emerged from general anesthesia smoothly and was extubated without any complication. Postoperative exacerbation of MS symptoms did not appear. However, he was rehospitalized because deep vein thrombosis (DVT) occurred after discharge and he received heparinization immediately. Eventually, he was discharged after a full recovery from DVT. We report a safe anesthetic management of the patient with MS, with the use of sevoflurane and with no the aggravation of MS during postoperative period.
Assuntos
Adulto , Humanos , Masculino , Androstanóis , Anestesia , Anestesia Geral , Apendicite , Emergências , Heparina , Intubação , Laparotomia , Éteres Metílicos , Esclerose Múltipla , Relaxamento Muscular , Óxido Nitroso , Paraplegia , Piperidinas , Período Pós-Operatório , Propofol , Estresse Psicológico , Incontinência Urinária , Trombose VenosaRESUMO
Endovascular stent graft placement is a minimally invasive technique that can be applied to treat many diseases of the descending thoracic aorta. For accurate stent graft placement, clear identification of aortic lesion is important and transesophageal echocardiography (TEE) is an ideal imaging tool for descending thoracic aortic aneurysms. Also TEE is able to detect a perigraft leak that cannot be confirmed by angiography. Unlike angiography, TEE image acquisition capability is not dependent on nephrotoxic contrast dye. The analysis of perioperative cardiac function provided by TEE may be helpful in the perioperative anesthetic management. Furthermore, the tip of the transesophageal echocardiographic probe can be used as a marker to guide stent graft positioning. We report a case of endovascular stent graft placement using TEE in a patient with descending thoracic aortic aneurysm under general anesthesia.