ABSTRACT
JUSTIFICATIVA E OBJETIVOS: Bloqueio do nervo frênico é um evento adverso do bloqueio do plexo braquial; entretanto, na sua maioria, sem repercussões clínicas importantes. O objetivo deste relato foi apresentar um caso em que ocorreu bloqueio do nervo frênico, com comprometimento ventilatório, em paciente com insuficiência renal crônica submetido a instalação de fístula arteriovenosa extensa, sob bloqueio do plexo braquial pela via perivascular interescalênica. RELATO DO CASO: Paciente do sexo masculino, 50 anos, tabagista, portador de insuficiência renal crônica em regime de hemodiálise, hipertensão arterial, hepatite C, diabetes mellitus, doença pulmonar obstrutiva crônica, a ser submetido à instalação de fístula arteriovenosa extensa no membro superior direito sob bloqueio de plexo braquial pela via interescalênica. O plexo braquial foi localizado com utilização do estimulador de nervo periférico. Foram injetados 35 mL de uma solução de anestésico local, constituída de uma mistura de lidocaína a 2 por cento com epinefrina a 1:200.000 e ropivacaína a 0,75 por cento em partes iguais. Ao final da injeção o paciente apresentava-se lúcido, porém com dispnéia e predomínio de incursão respiratória intercostal ipsilateral ao bloqueio. Não havia murmúrio vesicular na base do hemitórax direito. A SpO2 manteve-se em 95 por cento, com cateter nasal de oxigênio. Não foi necessária instalação de métodos de auxílio ventilatório invasivo. Radiografia do tórax revelou que o hemidiafragma direito ocupava o 5° espaço intercostal. O quadro clínico foi revertido em três horas. CONCLUSÕES: O caso mostrou que houve paralisia total do nervo frênico com sintomas respiratórios. Apesar de não ter sido necessária terapêutica invasiva para o tratamento, fica o alerta para a restrição da indicação da técnica nesses casos.
BACKGROUND AND OBJECTIVES: Phrenic nerve block is a common adverse event of brachial plexus block. However, in most cases it does not have any important clinical repercussion. The objective of this work was to report a case with phrenic nerve block with respiratory repercussions in a patient with chronic renal failure who had an extensive arteriovenous fistula created under perivascular interscalene brachial plexus block. CASE REPORT: A 50-year old male patient, smoker, with chronic renal failure on hemodialysis, hypertension, hepatitis C, diabetes mellitus, and chronic obstructive pulmonary disease, was scheduled for creation of an arteriovenous fistula in the right upper limb under interscalene brachial plexus block. The brachial plexus was identified by a peripheral nerve stimulator. Thirty-five milliliter of a local anesthetic mixture containing equal parts of 2 percent lidocaine with epinephrine at 1:200.000 and 0.75 percent ropivacaine were injected. After the injection, the patient was alert and oriented, but developed dyspnea and predominance of intercostal respiration on the side of the blockade. Breath sounds were not present in the right base. SpO2 was maintained at 95 percent with oxygen through nasal cannula. Institution of invasive ventilatory support was not necessary. A chest X-ray showed the right hemidiaphragm on the 5th intecostal space. The patient returned to normal after three hours. CONCLUSION: In this case, the patient developed complete paralysis of the phrenic nerve with respiratory symptoms. Although invasive treatment was not necessary, it is necessary to alert anesthesiologists to restrict the indication of this technique.
JUSTIFICATIVA Y OBJETIVOS: El bloqueo del nervio frénico es un evento adverso del bloqueo del plexo braquial, sin embargo, en su mayoría, sin repercusiones clínicas importantes. El objetivo de este relato fue presentar un caso en que ocurrió bloqueo del nervio frénico, con comprometimiento ventilatorio en paciente con insuficiencia renal crónica, sometido a la instalación de fístula arterio-venosa extensa, bajo bloqueo del plexo braquial por la vía perivascular interescalénica. RELATO DEL CASO: Paciente del sexo masculino, 50 años, tabaquista, portador de insuficiencia renal crónica en régimen de hemodiálisis, hipertensión arterial, hepatitis C, diabetes melito, enfermedad pulmonar obstructiva crónica, sometido a la instalación de fístula arterio-venosa extensa en el miembro superior derecho bajo bloqueo de plexo braquial por la vía interescalénica. El plexo braquial fue localizado con la utilización del estimulador de nervio periférico. Se inyectaron 35 mL de una solución de anestésico local constituida de una mezcla de lidocaína a 2 por ciento con epinefrina a 1:200.000 y ropivacaína a 0,75 por ciento en partes iguales. Al final de la inyección el paciente estaba lúcido, pero sin embargo con disnea y predominio de incursión respiratoria intercostal ipsilateral al bloqueo. No había murmullo vesicular en la base del hemitórax derecho. La SpO2 se mantuvo en un 95 por ciento, con catéter nasal de oxígeno. No fue necesaria la instalación de métodos de auxilio ventilatorio invasivo. La radiografía del tórax reveló que el hemidiafragma derecho ocupaba el 5° espacio intercostal. El cuadro clínico se revirtió en tres horas. CONCLUSIONES: El caso mostró que hubo parálisis total del nervio frénico con síntomas respiratorios. A pesar de no haber sido necesaria la terapéutica invasiva para el tratamiento, queda el aviso aquí para la restricción de la indicación de la técnica en esos casos.
Subject(s)
Humans , Male , Middle Aged , Brachial Plexus , Nerve Block , Phrenic NerveABSTRACT
BACKGROUND AND OBJECTIVES: Phrenic nerve block is a common adverse event of brachial plexus block. However, in most cases it does not have any important clinical repercussion. The objective of this work was to report a case with phrenic nerve block with respiratory repercussions in a patient with chronic renal failure who had an extensive arteriovenous fistula created under perivascular interscalene brachial plexus block. CASE REPORT: A 50-year old male patient, smoker, with chronic renal failure on hemodialysis, hypertension, hepatitis C, diabetes mellitus, and chronic obstructive pulmonary disease, was scheduled for creation of an arteriovenous fistula in the right upper limb under interscalene brachial plexus block. The brachial plexus was identified by a peripheral nerve stimulator. Thirty-five milliliter of a local anesthetic mixture containing equal parts of 2% lidocaine with epinephrine at 1:200.000 and 0.75% ropivacaine were injected. After the injection, the patient was alert and oriented, but developed dyspnea and predominance of intercostal respiration on the side of the blockade. Breath sounds were not present in the right base. SpO2 was maintained at 95% with oxygen through nasal cannula. Institution of invasive ventilatory support was not necessary. A chest X-ray showed the right hemidiaphragm on the 5th intecostal space. The patient returned to normal after three hours. CONCLUSION: In this case, the patient developed complete paralysis of the phrenic nerve with respiratory symptoms. Although invasive treatment was not necessary, it is necessary to alert anesthesiologists to restrict the indication of this technique.
Subject(s)
Brachial Plexus , Nerve Block , Phrenic Nerve , Humans , Male , Middle AgedABSTRACT
AIM: To evaluate the incidence of fungi in the ocular conjunctiva of sugar-cane cutting workers as well in a sugar-cane plantation environment. PLACE: Monte Belo - MG, Eye Clinic, Laboratory of Physiology and Biology of Microorganisms of Unifenas, Alfenas - MG. METHODS: Swabs were made from the ocular conjunctiva of one hundred workers of both sexes and material was collected from leaves, stalk, and the environmental air from the sugar-cane plantation. These were inoculated in specific mold media. After incubation at 25 degrees C for a period of fifteen days, the plates were analyzed and colony forming units (ufc) were identified using conventional mycological techniques. RESULTS: Of one hundred workers involved in this research, 64 presented one or more genera of fungi, 54 (84.38%) being identified in males and 10 (15.62%) identified in females. The separation of the workers by age range showed that the prevalence of observed fungi by age was not uniform. The highest incidences were found in advanced age ranges, the increase of positivity by age being considered statistically significant (p<0.05). The lowest prevalence (50%) was found in the 11-20-year-old interval, which presents the lowest number of examined persons. The highest positivity was verified in the 61-79 year interval. In 60 workers (93.75%) only one genus was isolated; in 3 (4.69%) two genera, and in only one worker (1.56%) three genera were isolated. The most prevalent isolated fungi were Fusarium sp (43.76%) and Geotrichum sp (23.44%), followed by Cladosporium sp (9.38%), Penicillium sp (7.81%), Mucor sp (9.38%) and Oidium sp (7.81%). The most common genus founded in leaves, stalk and air were Aspergillus, Penicillium, Fusarium, Cladosporium and Rhizopus. CONCLUSION: The environmental conditions, the socioeconomic status and the general and personal poor hygienic conditions, together with lack of information about prophylactic standards, surely led to the high incidence of ocular conjunctiva fungus isolation (67%). The incidence was much higher in males (84.38%) as (15.62%) in females. The anemophilious fungi and those isolated from stalk and leaves were similar to those already described in the literature. The isolated filamentous fungi were much more numerous than yeast, there being some correlation between these and the conjunctiva isolates.
Subject(s)
Conjunctiva/microbiology , Crops, Agricultural/microbiology , Fungi/isolation & purification , Occupational Exposure , Saccharum/microbiology , Adolescent , Adult , Aged , Brazil , Child , Female , Fungi/classification , Humans , Incidence , Male , Middle AgedABSTRACT
OBJETIVO: Avaliar a incidência de fungos na conjuntiva ocular de trabalhadores no corte de cana-de-açúcar bem como no ambiente canavieiro. MÉTODOS: Neste estudo, foram feitos "swabs" da conjuntiva ocular de 100 trabalhadores de ambos os sexos, sendo 86 do sexo masculino e 14 do feminino, e coleta do material das folhas e colmo do canavial, bem como do ar ambiente que foram em seguida semeados em meios específicos para fungos. Após incubação a 25°C por um período de até 15 dias, as placas foram analisadas sendo as Unidades Formadoras de Colônias (UFC) identificadas com técnicas micológicas convencionais. RESULTADO: Dos 100 trabalhadores envolvidos na pesquisa, 64 apresentaram um ou mais gêneros de fungos, sendo 54 (84,38 por cento) identificados em indivíduos do sexo masculino e 10 (15,62 por cento) identificados em indivíduos do sexo feminino. A divisão dos trabalhadores por faixa etária, demonstrou que a freqüência dos fungos observados não foi uniforme. As maiores incidências foram encontradas nas faixas etárias mais avançadas, sendo que o aumento de positividade encontrado foi considerado estatisticamente significativo (p£0,05). A freqüência mais baixa (50 por cento) ocorreu no intervalo de 11 a 20 anos, que apresentou o menor número de pessoas examinadas. A maior positividade foi verificada no intervalo de 31-40 e 51-60 anos. Em 60 trabalhadores (93,75 por cento) foi isolado somente um gênero; em 3 (4,69 por cento) dois gêneros e em apenas 1 trabalhador (1,56 por cento) foram isolados três gêneros de fungos. Os fungos mais freqüentemente isolados foram Fusarium sp (43,76 por cento) e Geotrichum sp (23,44 por cento), seguidos de Cladosporum sp (9,38 por cento), Penicillium sp (7,81 por cento), Mucor sp (9,38 por cento) e Oidium sp (7,81 por cento). Os gêneros mais encontrados nas folhas, colmo e ar foram Aspergillus, Penicillium, Fusarium, Cladosporium e Rhizopus. CONCLUSÃO: Apesar de não terem sido analisados os dados que...
AIM: To evaluate the incidence of fungi in the ocular conjunctiva of sugar-cane cutting workers as well in a sugar-cane plantation environment. PLACE: Monte Belo - MG, Eye Clinic, Laboratory of Physiology and Biology of Microorganisms of Unifenas, Alfenas - MG. METHODS: Swabs were made from the ocular conjunctiva of one hundred workers of both sexes and material was collected from leaves, stalk, and the environmental air from the sugar-cane plantation. These were inoculated in specific mold media. After incubation at 25°C for a period of fifteen days, the plates were analyzed and colony forming units (ufc) were identified using conventional mycological techniques. RESULTS: Of one hundred workers involved in this research, 64 presented one or more genera of fungi, 54 (84.38 percent) being identified in males and 10 (15.62 percent) identified in females. The separation of the workers by age range showed that the prevalence of observed fungi by age was not uniform. The highest incidences were found in advanced age ranges, the increase of positivity by age being considered statistically significant (p<0.05). The lowest prevalence (50 percent) was found in the 11-20-year-old interval, which presents the lowest number of examined persons. The highest positivity was verified in the 61-79 year interval. In 60 workers (93.75 percent) only one genus was isolated; in 3 (4.69 percent) two genera, and in only one worker (1.56 percent) three genera were isolated. The most prevalent isolated fungi were Fusarium sp (43.76 percent) and Geotrichum sp (23.44 percent), followed by Cladosporium sp (9.38 percent), Penicillium sp (7.81 percent), Mucor sp (9.38 percent) and Oidium sp (7.81 percent). The most common genus founded in leaves, stalk and air were Aspergillus, Penicillium, Fusarium, Cladosporium and Rhizopus. CONCLUSION: The environmental conditions, the socioeconomic status and the general and personal poor hygienic conditions, together with...