RESUMO
Myotonic dystrophy (DM), though rare, can significantly complicate anesthesia due to muscular and extra-muscular involvement. When this condition is compounded by a pheochromocytoma, anesthetizing such patients becomes extra challenging. We present a case report of a 61-year-old lady with congenital DM, with the whole gamut of associated features, was diagnosed with a noradrenaline secreting paraganglionoma following investigation of refractory hypertension. We anesthetized her for an open resection of the lesion. The conduct of anesthesia and recovery of this patient is described. Our experience suggests that anesthetizing these patients though challenging can be safely managed with relaxant general anesthesia and epidural analgesia with meticulous care pre, intra and post-surgical intervention.
Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Anestesia Geral/métodos , Vasoespasmo Coronário/tratamento farmacológico , Hipertensão/tratamento farmacológico , Distrofia Miotônica/complicações , Paraganglioma/cirurgia , Assistência Perioperatória , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias das Glândulas Suprarrenais/diagnóstico , Antagonistas Adrenérgicos alfa/uso terapêutico , Antagonistas Adrenérgicos beta/uso terapêutico , Anestesia Epidural , Anestésicos Intravenosos/administração & dosagem , Anestésicos Locais/administração & dosagem , Catecolaminas/sangue , Catecolaminas/urina , Vasoespasmo Coronário/etiologia , Vasoespasmo Coronário/urina , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/urina , Pessoa de Meia-Idade , Paraganglioma/complicações , Paraganglioma/diagnóstico , Fenoxibenzamina/uso terapêutico , Feocromocitoma/complicações , Feocromocitoma/diagnóstico , Propranolol/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
Removal of intracardiac air during valvular surgery should be accomplished in the most effective manner. We conducted a prospective randomized controlled trial to compare mechanical de-airing and carbon dioxide (CO2) field flooding in 18 patients undergoing elective valvular surgery. Transoesophageal echocardiography was used to record intracardiac bubbles, and this was assessed postoperatively by two independent echocardiographers blinded to treatment group. Both assessors graded the bubble count higher in the mechanical deairing group compared with the CO2 flooding group, and there was good agreement between assessors. CO2 field flooding is more effective than mechanical de-airing in removing intracardiac bubbles following valvular surgery.
