Anestesia epidural para nefrectomía abierta en paciente con bullas gigantes bilaterales
DOI:
https://doi.org/10.30445/rear.v5i3.291Palabras clave:
anestesia epidural, torácicaResumen
Las nefrectomías por vía abierta son intervenciones agresivas que suelen ser realizadas con el paciente sometido a anestesia general, lo cual implica el empleo de ventilación mecánica y la aplicación de presiones positivas en la vía aérea. Sin embargo, el barotrauma asociado a la ventilación mecánica puede producir un neumotórax si el paciente presenta bullas pulmonares, por lo que en esta circunstancia concreta la relación beneficio-riesgo puede ser desfavorable a la anestesia general con ventilación mecánica y favorecer opciones menos habituales en las que el paciente mantenga la respiración espontánea 1-6.
Presentamos el caso de un paciente con bullas gigantes bilaterales que fue intervenido satisfactoriamente de nefrectomía abierta bajo anestesia epidural y sedación intravenosa, con preservación de la respiración espontánea.
Citas
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2.- Nozaki K, Endou A, Sakurai K, Takahata O, Iwasaki H. Anesthetic management of a patient with a giant bulla and liver cirrhosis using a laryngeal mask airway and epidural analgesia. Masui 2001;50(6):639-641.
3.- Yen CR, Tsou MY, Lin SM, Chan KH, Chu YC. Thoracic anesthesia for a polymyositis patient undergoing awake mini-thoracotomy and unroofing of a huge pulmonary bulla. Acta Anaesthesiol Taiwan 2008;46(1):42-45.
4.- Suga K, Yoshida A, Kamada T, takao R, Kaneko T, Kobayashi Y. Respiratory management for a patient with a giant bulla and pulmonary dysfunction during off-pump coronary artery bypass grafting. Masui 2010;59(2):216-219.
5.- Sugiura T, Akiyoshi R, Kato R, Sasano H, Sobue K. Interscalene block combined with general anesthesia under spontaneous breathing in a patient with a giant bulla. Masui 2011;60(9):1101-1103.
6.- Kamath S, Bhadrinarayan V, Ranjan M, Umamaheswara Rao GS. Alternative approach for the anesthetic management of a patient with large pulmonary bulla presenting with an intracranial tumor for surgery. J Anesthesiol Clin Pharmacol 2012;28(2):272-273.
7.- Caseby NG. Anaesthesia for the patient with a coincidental giant lung bulla: a case report. Can Anaesth Soc J 1981;28(3):272-276.
8.- Van Lier F, van der Geest PJ, Hoeks SE, van Gestel YR, Hol JW, Sin DD, et al. Epidural analgesia is associated with improved health outcomes of surgical patients with chronic obstructive pulmonary disease. Anesthesiology 2011;115(2):315-321.
9.- Seigne PW, Hartigan PM, Body SC. Anesthetic considerations for patients with severe emphysematous lung disease. Int Anesthesiol Clin 2000;38(1):1-23.
10.- Edrich T, Sadovnikoff N. Anesthesia for patients with severe chronic obstructive pulmonary disease. Curr Opin Anaesthesiol 2010;23(1):18-24.
11.- Usukura A, Tsubokawa T, Yamamoto K. Anesthetic management of a patient with severe combined pulmonary disease under epidural anesthesia with spontaneous respiration. Masui 2008;57(5):624-627.
12.- Morton G, Bowler I. Combined spinal-epidural as an alternative method of anaesthesia for a sigmoid-colectomy. Anaesthesia 2001;56(8):815-816.
13.- Kapala M, Meterissian S, Schricker T. Neuraxial anesthesia and intraoperative bilevel positive airway pressure in a patient with severe chronic obstructive pulmonary disease and obstructive sleep apnea undergoing elective sigmoid resection. Reg Anesth Pain Med 2009;34(1):69-71.
14.- Cortiñas Sáenz M, Jiménez Vizuete JM, Vega Pérez F, Rubio González MV, Peyró García R, Cuesta Tobarra J. Colecistectomía abierta bajo anestesia epidural torácica en enfermedades intersticiales difusas del pulmón. Rev Esp Anestesiol Reanim 2004;51(3):164-167. )
15.- Muñoz Rosado G, Alamán Orbañanos B, Moro Velasco C, García Porras R. Colecistectomía abierta bajo anestesia epidural torácica en pacientes con enfermedad pulmonar severa. Rev Esp Anestesiol Reanim 2008;55(10):648-650.
16.- Buzzetti V, Dellino E, Veschi G, Aveni MR, Quarenghi E. Nephrectomy in pulmonary tuberculosis patients: an anesthesiological approach. Arch Ital Urol Nefrol Androl 1991;63(3):351-354.
17.- Johnson TV, Bond N, Master VA. Radical nephrectomy via epidural-only anesthesia. Can J Urol 2010;17(5):5401-5402.
18.- Akpek E, Kayhan Z, Kaya H, Candan S, Haberal M. Epidural anesthesia for renal transplantation: a preliminary report. Transplant Proc 1999;31(8):3149-3150.
19.- Haberal M, Emiroğlu R, Arslan G, Apek E, Karakayali H, Bilgin N. Living-donor nephrectomy under combined spinal-epidural anesthesia. Transplant Proc 2002;34(6):2448-2449.
20.- Akpek EA, Kayhan Z, Dönmez A, Moray G, Arslan G. Early postoperative renal function following renal transplantation surgery: effect of anesthetic technique. J Anesth 2002;16(2):114-118.
21.- Sener M, Torgay A, Akpek E, Colak T, Karakayali H, Arslan G, et al. Regional versus general anesthesia for donor nephrectomy: effects on graft function. Transplant Proc 2004;36(10):2954-2958.
22.- Sener M, Torgay A, Akpek E, Aktas A, Colak T, Karakayali H, et al. The effect of anesthetic technique on early postoperative renal function after donor nephrectomy: a preliminary report. Transplant Proc 2005;37(5):2023-2027.
2.- Nozaki K, Endou A, Sakurai K, Takahata O, Iwasaki H. Anesthetic management of a patient with a giant bulla and liver cirrhosis using a laryngeal mask airway and epidural analgesia. Masui 2001;50(6):639-641.
3.- Yen CR, Tsou MY, Lin SM, Chan KH, Chu YC. Thoracic anesthesia for a polymyositis patient undergoing awake mini-thoracotomy and unroofing of a huge pulmonary bulla. Acta Anaesthesiol Taiwan 2008;46(1):42-45.
4.- Suga K, Yoshida A, Kamada T, takao R, Kaneko T, Kobayashi Y. Respiratory management for a patient with a giant bulla and pulmonary dysfunction during off-pump coronary artery bypass grafting. Masui 2010;59(2):216-219.
5.- Sugiura T, Akiyoshi R, Kato R, Sasano H, Sobue K. Interscalene block combined with general anesthesia under spontaneous breathing in a patient with a giant bulla. Masui 2011;60(9):1101-1103.
6.- Kamath S, Bhadrinarayan V, Ranjan M, Umamaheswara Rao GS. Alternative approach for the anesthetic management of a patient with large pulmonary bulla presenting with an intracranial tumor for surgery. J Anesthesiol Clin Pharmacol 2012;28(2):272-273.
7.- Caseby NG. Anaesthesia for the patient with a coincidental giant lung bulla: a case report. Can Anaesth Soc J 1981;28(3):272-276.
8.- Van Lier F, van der Geest PJ, Hoeks SE, van Gestel YR, Hol JW, Sin DD, et al. Epidural analgesia is associated with improved health outcomes of surgical patients with chronic obstructive pulmonary disease. Anesthesiology 2011;115(2):315-321.
9.- Seigne PW, Hartigan PM, Body SC. Anesthetic considerations for patients with severe emphysematous lung disease. Int Anesthesiol Clin 2000;38(1):1-23.
10.- Edrich T, Sadovnikoff N. Anesthesia for patients with severe chronic obstructive pulmonary disease. Curr Opin Anaesthesiol 2010;23(1):18-24.
11.- Usukura A, Tsubokawa T, Yamamoto K. Anesthetic management of a patient with severe combined pulmonary disease under epidural anesthesia with spontaneous respiration. Masui 2008;57(5):624-627.
12.- Morton G, Bowler I. Combined spinal-epidural as an alternative method of anaesthesia for a sigmoid-colectomy. Anaesthesia 2001;56(8):815-816.
13.- Kapala M, Meterissian S, Schricker T. Neuraxial anesthesia and intraoperative bilevel positive airway pressure in a patient with severe chronic obstructive pulmonary disease and obstructive sleep apnea undergoing elective sigmoid resection. Reg Anesth Pain Med 2009;34(1):69-71.
14.- Cortiñas Sáenz M, Jiménez Vizuete JM, Vega Pérez F, Rubio González MV, Peyró García R, Cuesta Tobarra J. Colecistectomía abierta bajo anestesia epidural torácica en enfermedades intersticiales difusas del pulmón. Rev Esp Anestesiol Reanim 2004;51(3):164-167. )
15.- Muñoz Rosado G, Alamán Orbañanos B, Moro Velasco C, García Porras R. Colecistectomía abierta bajo anestesia epidural torácica en pacientes con enfermedad pulmonar severa. Rev Esp Anestesiol Reanim 2008;55(10):648-650.
16.- Buzzetti V, Dellino E, Veschi G, Aveni MR, Quarenghi E. Nephrectomy in pulmonary tuberculosis patients: an anesthesiological approach. Arch Ital Urol Nefrol Androl 1991;63(3):351-354.
17.- Johnson TV, Bond N, Master VA. Radical nephrectomy via epidural-only anesthesia. Can J Urol 2010;17(5):5401-5402.
18.- Akpek E, Kayhan Z, Kaya H, Candan S, Haberal M. Epidural anesthesia for renal transplantation: a preliminary report. Transplant Proc 1999;31(8):3149-3150.
19.- Haberal M, Emiroğlu R, Arslan G, Apek E, Karakayali H, Bilgin N. Living-donor nephrectomy under combined spinal-epidural anesthesia. Transplant Proc 2002;34(6):2448-2449.
20.- Akpek EA, Kayhan Z, Dönmez A, Moray G, Arslan G. Early postoperative renal function following renal transplantation surgery: effect of anesthetic technique. J Anesth 2002;16(2):114-118.
21.- Sener M, Torgay A, Akpek E, Colak T, Karakayali H, Arslan G, et al. Regional versus general anesthesia for donor nephrectomy: effects on graft function. Transplant Proc 2004;36(10):2954-2958.
22.- Sener M, Torgay A, Akpek E, Aktas A, Colak T, Karakayali H, et al. The effect of anesthetic technique on early postoperative renal function after donor nephrectomy: a preliminary report. Transplant Proc 2005;37(5):2023-2027.
Publicado
2013-03-31
Cómo citar
Monsalve Naharro, J. Ángel. (2013). Anestesia epidural para nefrectomía abierta en paciente con bullas gigantes bilaterales. Revista Electrónica AnestesiaR, 5(3), 4. https://doi.org/10.30445/rear.v5i3.291
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Revista Electrónica AnestesiaR by 