RESUMO
Se presenta el caso de un varón de 62 años programado para una cistectomía radical que a los 10 min de comenzar la cirugía presentó hipotensión arterial severa, taquicardia sinusal y un aumento de las presiones en la vía aérea. No se obtuvo respuesta a la administración de diversos fármacos vasoactivos (efedrina, fenilefrina, dopamina, noradrenalina). Tras descartar otras posibles etiologías se valoró la posibilidad de que se tratara de una reacción de anafilaxia y se inició la administración de adrenalina, con lo que se consiguió estabilizar hemodinámicamente al paciente. En la unidad de reanimación fue preciso mantener la perfusión de adrenalina y la ventilación mecánica durante 4 días (AU)
We present a case of a 62 year-old male scheduled for radical cystectomy, who, ten minutes into the surgery, presented with severe hypotension, tachycardia and increased airway pressure. There was no response to the administration of vasoactive drugs such as, ephedrine, phenylephrine, dopamine and norepinephrine. After ruling out several causes, we evaluated the possibility of an anaphylactic reaction. Adrenaline was given, and the patient stabilized. An adrenaline infusion and mechanical ventilation was required for four days in the critical care unit (AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Anafilaxia/complicações , Anafilaxia/diagnóstico , Anafilaxia/tratamento farmacológico , Epinefrina/uso terapêutico , Vasoconstritores/uso terapêutico , Anestesia/métodos , Anestesia , Midazolam/uso terapêutico , Epinefrina/metabolismo , Hipotensão/induzido quimicamente , Hipotensão/complicações , Cistectomia/métodos , Taquicardia Sinusal/complicações , Hemodinâmica/fisiologia , Respiração Artificial/métodos , Respiração Artificial , Propofol/uso terapêutico , Fentanila/uso terapêuticoRESUMO
We present a case of a 62 year-old male scheduled for radical cystectomy, who, ten minutes into the surgery, presented with severe hypotension, tachycardia and increased airway pressure. There was no response to the administration of vasoactive drugs such as, ephedrine, phenylephrine, dopamine and norepinephrine. After ruling out several causes, we evaluated the possibility of an anaphylactic reaction. Adrenaline was given, and the patient stabilized. An adrenaline infusion and mechanical ventilation was required for four days in the critical care unit.
