RESUMO
The BIS-index data show that an opiate as Fentanyl is advisable with associations Cisatracurium/Propofol or Vecuronium/Propofol. It is possible to use in these cases a drip infusion to avoid the risk of awareness during intubation.
Assuntos
Anestesia Geral/métodos , Atracúrio/análogos & derivados , Conscientização , Monitorização Intraoperatória/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Anestésicos Intravenosos/administração & dosagem , Atracúrio/administração & dosagem , Quimioterapia Combinada , Eletroencefalografia/efeitos dos fármacos , Potenciais Evocados Auditivos/efeitos dos fármacos , Feminino , Fentanila/administração & dosagem , Humanos , Infusões Intravenosas , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Bloqueadores Neuromusculares/administração & dosagem , Fármacos Neuromusculares não Despolarizantes/administração & dosagem , Propofol/administração & dosagem , Brometo de Vecurônio/administração & dosagemRESUMO
The literature considers hyperthermic intraoperative intraperitoneal chemotherapy a safe and effective procedure for peritoneal carcinomatosis, but a technical improvement is necessary. Regional chemotherapy anticipates the "downfall" of tumoral cells in the peritoneum. The Authors considered 5 patients--female, age 27-45 years, ASA 2--operated of peritonectomy in ovaric neoplasia with peritoneal metastasis. The hyperthermic intraoperative intraperitoneal chemotherapy has been made at the end of the surgery with a hot solution (43 degrees C): 3000 ml of dextrose 1.5% with mytomicina C 25 mg e cysplatino 75 mg/m2. We considered variation of emodinamic parametres (blood pressure, central venous pressure, stroke volume, etc.) and biochemical parametres (Na, K, CI-, CO2, etc.). These parametres have been correlated with some complications: fistula, anastomotic leakage, pancreatitis and postoperative bleeding.
Assuntos
Antibióticos Antineoplásicos/administração & dosagem , Antineoplásicos/administração & dosagem , Cisplatino/administração & dosagem , Infusões Parenterais , Mitomicina/administração & dosagem , Neoplasias Peritoneais/tratamento farmacológico , Adulto , Anestesia , Feminino , Hemodinâmica , Humanos , Hipertermia Induzida , Cuidados Intraoperatórios , Pessoa de Meia-Idade , Neoplasias Ovarianas , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/cirurgia , Complicações Pós-OperatóriasRESUMO
Most cases of total spinal block have been reported in the literature. The displacement of the catheter and the consequent dural perforation are the causes in large percentage of the patients (75%). The Authors describe this case for the importance of the causes and outcome of the patient. A 48 years old woman presented for hysterectomy for uterine fibromas. After having individualized the L3-L4 interspace, a test dose of 3 ml carbocaine 2% was injected. After that, the spinal block was obtained using ropivacaine 0.75% (total dose = 10 ml) injecting slowly, in following times, 5+5 ml of anaesthetic solution. The patient, perfectly conscious at first, presented a gradual increase of the difficulty in talking and breathing. Subsequently she showed a complete paralysis with loss of the consciousness, respiratory arrest, bilateral and symmetrical midriasis, as well as total areflexia. Endotracheal tube was placed. After eighty minutes from the end of the administration of the local anesthetic, spontaneous thoracic excursions appeared, even though of moderate ampleness, midriasis reduced. The patient recovered consciousness and sufficiently ventilated; therefore the endotracheal tube was removed.