Aldrete JA, Ferrari HA

Language: Spanish
References: 17
Page: 81-85
PDF size: 122.61 Kb.

ABSTRACT

Objectives: In addition of the usual care required when extensive abdominal surgery is performed, certain special precautions are considered necessary in patients with sickle-cell disease. One such case thatreceived thoracic epidural and general anesthesia developed a major neurological deficit as some of these precautions seem to have been forsaken. Methods: A 19 year old man with sickle cell disease received epidural and general anesthesia for a cystectomy, lymph node dissection and cholecystectomy lasting 9½ h. He received 2% Lidocaine with 1:200,000 epinephrine in bolus intermittently, for a total of 1,240 mg and 310µg ,respectively. SaO₂ ran between 96 and 100%. Upon conclusion of surgery, the epidural catheter was infused with meperidine 0.1% and bupivacaine 0.1% until it was found to have motor and sensory block to L2 level. An MRI revealed an infarct in the conus medularis. Results: The patient has remained paraplegic including bowel and bladder dysfunction for over 4 years. Conclusion: Though acceptable SaO₂ were present throughout the procedure,the patients temperature fell near 35°C, there was evidence of sickling and hemolysis. No changes have occurred in the neurological deficit of the patient in the last fewer years. Other possible causes are discussed

REFERENCES

1. Gibson JR. Anesthesia for sickle cell disease and other hemoglobinopathies. Seminars in Anesthesiology 1987;6:27-38.

2. Hain WR. Diseases of blood. In: Katz J, Steward DJ (eds): Anesthesia and Uncommon Pediatric Diseases, p 489. Philadelphia, WB Saunders, 1987.

3. Luban NLC, Epstein BS, Watson SP. Sickle cell disease and anesthesia. Advances in Anesthesiology 1984;1:289.

4. Heiner M, Teasdale SJ, David T, et al. Aortocoronary bypass in a patient with sickle cell trait. Can Anaesth Soc J 1979;26:428.

5. Flye MW, Silver D. Billiary tract disorders and sickle cell disease. Surgery 1972;72:361.

6. Usubiaga JE, Kolodney J, Usubiaga LE. Neurological complications of prevertebral surgery under regional anesthesia. Surgery 1970;66:366-370.

7. Baintaon CR, Stritchartz CR. Concentration dependence of lidocaine-induced irreversible conduction loss in frog nerves. Anesthesiology 1994;81:657-67.

8. Hashimoto K, Hampl KF, Nakamura Y, Bollen AW, Feiner, J, Drasner K. Epinephrine increases the neurotoxic potential of intrathecally administered lidocaine in the rat. Anesthesiology 2001;94:876-81.

9. Porter SS, Albin MS, Watson WA, Bunegin L, Pantoja G. Spinal cord and cerebral blood flow responses to subarachnoid injection of local anesthetics with and without epinephrine. Acta Anaesthesiol Scand 1985;29:330-8.

10. Wang Hillman DE, Spielholz NI, Tundorf H. Chronic neurological deficits and Nesacaine-CE: an effect of the anesthetic, 2-chloroprocaine or the antioxidant, sodium bisulfite? Anesth Analg 1984;63:445-7.

11. Tapia DP, Waxler BJ, Hursh D, Aldrete JA. Effect of sodium bisulfite on Sprague-Dawley rat sciatic nerve. A preliminary report. Reg Anesth 1990;15(1S):90.

12. Aldrete JA. Anesthetic substances in the spine. In: Arachnoiditis: the Silent epidemic. JA Aldrete (ed) Denver, Futuremed Publishers. 2000.pp. 77-102.

13. Rydevitz B, Holm S, Brown MD, et al: Diffusion of the CSF as a nutritional pathway for spinal nerve roots. Acta Physiol Scand 1990;138:247-8.

14. Sakura S, Morimoto SM, Saito Y. The addition of epinephrine increases intensity of sensory block during epidural anesthesia with lidocaine. Reg Anesth Pain Med 1999;24:541-6.

15. Aldrete JA, Guerra F. Hematological diseases. In: Anesthesia for Uncommon Diseases, Katz J, Benumoff JL, Kadis A (eds). WB Saunders, Co. 1981.pp. 313-83.

16. Bhattacharyya BN. Perioperative management for cholecystectomy in sickle cell disease. J Pediatr Surg 1993;28:72.

17. Bracken MB, Shepard MJ, Collins WF, et al. Methylprednisolone or naloxone treatment after spinal cord injury. 1 year follow-up data. J Neurosurgery 1992;6:23-31.