RESUMO
We reviewed a case of bilateral sphenopalatine ganglion (SPG) blockade with liposomal bupivacaine for sinus surgery. The case was complicated by severe postoperative hypertension refractory to antihypertensives and needing intensive care unit (ICU) admission. While SPG blockade has been used to treat headaches and provide perioperative analgesia, this complication and a possible mechanism have not been described. We discuss how local anesthetic spread beyond the SPG may have caused prolonged parasympathetic blockade and hypertension. Before approved indications are established, we recommend avoiding the use of liposomal bupivacaine in off-label settings when the function of bilateral autonomic structures could be affected.
Assuntos
Hipertensão , Bloqueio do Gânglio Esfenopalatino , Anestésicos Locais , Bupivacaína , HumanosRESUMO
The synthesis and characterization, by optical spectroscopy, mass spectrometry, superconducting quantum interference device (SQUID) magnetometry, and single-crystal X-ray diffraction, of six iron complexes of tetraanthracenotetraazaporphyrin (TATAP) are reported. Eight benzo groups, flanking the macrocycle periphery, form a nonpolar "bowl" on each face of the porphyrazine and prevent mu-oxo dimer formation. Fe(TATAP) readily binds THF, a variety of neutral nitrogenous axial ligands, and carbon monoxide. The equilibrium binding constants for the first two are higher than those of analogous porphyrins while those of the latter are smaller. We attribute these differences to the higher pi acidity of the porphyrazine ligand. Fe(TATAP) also shows different relative magnitudes of the successive equilibrium binding constants, K1 and K2, for hindered nitrogenous ligands when compared to those of porphyrin analogues. Surprisingly, Fe(TATAP), in toluene solution, shows no affinity for O2 when exposed to 1 atm partial pressure of O2 at 25 degrees C. These results are explained in terms of an unusually positive iron(III/II) redox potential when coordinated by the TATAP ligand.
