Caso clinico Key points Discussione Conclusioni · 2020. 3. 14. · Metodica AS ... Agenda •Caso...
Transcript of Caso clinico Key points Discussione Conclusioni · 2020. 3. 14. · Metodica AS ... Agenda •Caso...
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Arresto cardiaco dopo
anestesia spinale Scuola di Specializzazione in Anestesia, Rianimazione e T. I.
Clinica di Anestesia e Rianimazione
Direttore: Prof. G. Della Rocca
Università degli Studi di Udine Tutor: Specializzanda: Dr. M. Divella Dr.ssa L. Parisella
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Agenda
• Caso clinico
• Key points
• Discussione
• Conclusioni
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Caso clinico F.J., M, 23 aa
Peso 95 kg, Altezza 177 cm, BMI 30.3
Candidato per ricostruzione LCA ginocchio destro
Anamnesi
Negativa per patologie di rilievo
Nega allergie
Fumatore
METs > 7
ASA 1
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Caso clinico Esame obiettivo
MV normotrasmesso su tutto l’ambito polmonare
Eupnoico, SpO2 99% in aa
PA 120/80 mmHg, FC 72 bpm
Vie aeree nella norma
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Caso clinico
Monitoraggio intraoperatorio
ECG
NIBP
SpO2
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12 13
FiO2 0.21
MIDAZOLAM mg 1
CEFAZOLINA g 2
RA (18G) mL/kg/h 1
SpO2 % 99 99 99
140
120
100
80
60
40
Modalità Ventilatoria RS
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Caso clinico
h 12:25
• Ecoguidato continuo + ENS > 0.4 mA, Levobupivacaina 0.25% 20 mL.
h 12:48
• Pz in decubito laterale dx
• Puntura in L3-L4
• Ago Sprotte 25 G 90 mm
• Bupivacaina iperbarica 0.5% 10 mg in 1 minuto
Blocco nervo femorale destro:
Anestesia subaracnoidea:
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Caso clinico
h 12:57
• Livello termico: T6 unilaterale dx
• Pz decubito laterale dx , anti-Trendelemburg 10°, vigile, emodinamicamente stabile (HR 80 bpm, AP 130/70 mmHg ), SpO2 99%
h 12:59
• Nausea bradicardia severa asistolia al monitor + assenza polso carotideo massaggio cardiaco esterno per 1 minuto
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12 13
FiO2 0.21 1
MIDAZOLAM mg 1
CEFAZOLINA 2
ATROPINA mg 1
RA (18 G) mL/kg/h 1
SpO2 % 99 99 99 98 98
140
120
100
80
60
40
MODALITA’ VENTILATORIA RS V ASS
ACC
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Caso clinico
h 13:00
• Ripresa ritmo sinusale, HR 110 bpm, AP 120/60 mmHg, SpO2 98%, Pz vigile e cosciente. • Livello termico: T4 unilaterale dx
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12 13 14 15
FiO2 0.21 1 0.4
MIDAZOLAM mg 1
CEFAZOLINA 2
ATROPINA mg 1
RA (18 G) mL/kg/h 1
SpO2 % 99 98 99 99
140
120
100
80
60
40
Modalità Ventilatoria
RS V ASS RS
ACC
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h 15:15
•Livello termico: T 10 dx
•Bromage: 2 dx
Caso clinico
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Agenda
• Caso clinico
• Key points
• Discussione
• Conclusioni
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Key points
1. Arresto cardiaco in AS
2. Metodica AS
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Discussione
1. Arresto cardiaco in AS Incidenza Fattori di rischio
2. Metodica AS
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Minerva Anestesiol 2006;27:689-722
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Anesthesiology 2002; 97: 1274-80
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Discussione
1. Arresto cardiaco in AS Incidenza Fattori di rischio
2. Metodica AS
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✔
✔
✔
✔
✔
✔
Anesth. Analg. 2001; 92:252-6
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Anesth. Analg. 2001; 92:252-6
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British Journal of Anaesthesia 1995; 74: 41-45
adolescente
adulto
N = 132
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Discussione
1. Arresto cardiaco in AS
2. Metodica AS Dosaggio AL Velocità di iniezione
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Anesth Analg 2001; 93: 1377-9
N = 106
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J. Clin. Anesth. 2003; 15: 351-356
N = 90
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Local and Regional Anesthesia 2010; 3: 85-91
GRUPPO 1: 5 mg GRUPPO 2: 7.5 mg GRUPPO 3: 10 mg GRUPPO 4: 12.5 mg
N = 80
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Discussione
1. Arresto cardiaco in AS
2. Metodica AS Dosaggio AL Velocità di iniezione
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Does speed of intrathecal injection affect the distribution of 0.5% hyperbaric bupivacaine? A. Casati, G. Fanelli, G. Cappellari, A. Leoni, M. Berti, G. Aldeghieri and G. Torri
British Journal of Anaesthesia 1998; 81: 355-357
In 80 secondi
In 6 secondi
N = 60
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J. Anesth. 2011; 25: 380-385
ES: 0.5 ml/min
N = 66
D = dependent side
ND = non dependent side
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Agenda
• Caso clinico
• Key points
• Discussione
• Conclusioni
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Conclusioni 1
• DOSAGGIO:
Letteratura 4-7.5 mg ATS ginocchio
Caso clinico 10 mg ATS ricostruzione LCA
• VELOCITA’:
Letteratura 0.5 mL/min AS selettiva
Caso clinico 2mL/min
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Conclusioni 2
• TECNICA: Letteratura passaggio decubito laterale posizione supina Caso clinico pz ancora in decubito laterale e con ice-test T6 a dx
• FARMACO:
Letteratura Brand Caso clinico Generico