RESUMO
Vocal cord dysfunction (VCD) is a respiratory condition characterized by the paradoxical closure of the vocal cords. This condition results in a myriad of symptoms that would be expected from an upper airway obstruction including anxiety, hyperventilation, wheezing, stridor, shortness of breath, dyspnea, and suprasternal and neck muscle retraction. with known VCD who underwent local anesthesia with intravenous sedation for perianal skin tag removal. Postoperatively, the patient experienced respiratory distress, prompting interventions and investigation. A review of the literature revealed limited information on VCD, and no anesthesia literature was found regarding this entity.
Assuntos
Anestesia Intravenosa/efeitos adversos , Anestesia Local/efeitos adversos , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/etiologia , Doença Aguda , Adulto , Período de Recuperação da Anestesia , Doenças do Ânus/cirurgia , Asma/complicações , Exercícios Respiratórios , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Respiração com Pressão Positiva , Enfermagem em Pós-Anestésico/métodos , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/enfermagem , Fatores de Risco , Dermatopatias/cirurgia , Paralisia das Pregas Vocais/terapiaRESUMO
A common anesthetic technique for the upper extremity is local brachial plexus anesthesia using levobupivacaine and ropivacaine. To our knowledge, no study has been performed measuring differences in analgesic efficacy and latency when these local anesthetics are used for brachial plexus anesthesia. We enrolled 54 adults, assessed as ASA class I or II, into this double-blind, prospective investigation to receive 40 mL of 0.5% ropivacaine or levobupivacaine with 1:200,000 epinephrine. Pain was assessed using a 0 to 10 verbal numeric rating scale (VNRS). Motor blockade was determined using a modified Bromage scale. Variables included analgesic duration, latency, and overall patient satisfaction. The ropivacaine group had significantly higher VNRS scores at the 8th (P= .001) and 10th (P = .003) postoperative hours. The duration of sensory analgesia was significantly longer in the levobupivacaine group (831 minutes) than in the ropivacaine group (642 minutes, P = .013). Return of motor activity was significantly faster in the ropivacaine group (778 minutes) than in the levobupivacaine group (1,047 minutes; P = .001). No other significant differences were noted between the groups. When considering levobupivacaine and ropivacaine for brachial plexus anesthesia, levobupivacaine should be considered when postoperative analgesia is a concern but not when an early return of motor activity is required.
