Abstract

AGUIRRE-CASTRO, GD et al. Spinal erector block and total intravenous anesthesia in a patient with cardiac failure subjected to videothoracoscopy. Anest. Méx. [online]. 2019, vol.31, n.2, pp.67-73. ISSN 2448-8771.

A 68 year old female, hypertensive patient, treated with telmisartan/hydrochlorothiazide 80/12.5/24h. History of Dyspnea of small efforts, orthopnea, hypotension the supine, bilateral pleural effusion, pericardial effusion, heart failure with LVEF 20%, with very rapid evolution (2-3 months). Origin of bilateral pleural effusions so far of idiopathic origin. Requested anesthetic time to have videotoracopia diagnosed, bilateral pleural effusion, pericardial window drainage, take biopsies pleural and Mediastinal, abrasive and chemical pleurodesis. Anesthetic plan to: lock the bilateral spinal erector with total intravenous anesthesia (TIVA), remifentanil in perfusion system continues with etomidate. Conclusion: The blocking of the spinal erector decreased consumption of opioid to half the expected, as well as allowing good in the intraoperative and postoperative pain management. We did not have hemodynamic variations at the time of its application, despite being a susceptible patient to hypotension to the supine position. Etomidate did nót allow variations in the hemodynamics at the time of the induction and maintenance of anesthesia. The remifentanil allowed to maintain a constant opioid infusion including a post-extubation time, having the advantage of being an opioid of begining and fast metabolism.

Keywords : blockade of the bilateral spinal erector; regional anesthesia; anesthesia intravenuos; videothorascopy.