The Ultrasonography-Guided Femoral-Siatic Block in Patient with High Cardiac Risk

Öz

In patients with high cardiac risk general and spinal anesthesia considered contraindicated because of hemodynamic sensitivity and anticoag-ulant use. Peripheral nevre blocks that minimal effect on hemodynamic status are seen as a safer anesthetic method. In this case report, we present combined femoral-sciatic nerve block in a patient, has a near time myokard infarction story with high cardiac risk. During the surgery patient did not need any additional analgesic and anesthetic drugs. No complications observed in peroperative and early postoperative peri-od. In conclusion, combined sciatic-femoral nerve block can be used as an effective and safer anesthetic method for lower extremity surgery in patients with high cardiac risk. 

Anahtar Kelimeler

• Regional anesthesia,combined femoral-siatic block,high cardiac risk

Yüksek Kardiyak Riskli Olguda Ultrasonografi Eşliğinde Kombine Femoral-Siyatik Blok

Öz

Yüksek kardiyak riskli hastalarda, hemodinamik duyarlılık ve antikoagülan kullanımı nedeniyle genel ve spinal anestezi kontraendi-ke olarak kabul edilmektedir. Hemodinami üzerine etkileri minimal olan periferik sinir blokları yüksek riskli hasta grubunda daha güvenli bir anestezi yöntemi olarak görülmektedir. Bu olgu sunumunda yakın zamanlı miyokard infarktüsü geçmişi olan yüksek riskli kardiyak hastada kombine femoral –siyatik blok uygulamasını sunuyoruz. Hastada operasyon süresince ek anestezi ve analjezi ihtiyacı gözlenmedi. Peroperatif ve erken postoperatif dönemde komplikasyona rastlanmadı. Sonuç olarak kombine femoral –siyatik blok yüksek riskli hastalarda alt ekstremite cerrahilerinde etkin ve güvenli bir anestezi yöntemi olarak uygulanabilir. 

Anahtar Kelimeler

• Rejyonel anestezi,yüksek kardiyak risk,kombine femoal-siyatik blok

Kaynakça

1. 1.Mollhoff T, Theilmeir G, Aken HV. Regional anaesthesia in patients at coronary risk for noncardiac and cardiac surgery. Current Opinion in Anesthesiology 2001; 14: 17- 25
2. 2. Karcıoğlu M,TuzcuK,DavarcıI,BozdoğanY,TurhanoğluS,AkçayA,Altaş M. Çok Yüksek Riskli Koroner Arter Hastalığı ve Dejeneratif Kalp Kapağı Olan Bir Hastanın Acil Spinal Cerrahisinde Başarılı Bir Anestezi Uygulaması; GKDA Derg 17(4):91-95, 2011 doi:10.5222/GKDAD.2011.091
3. 3. Aygan İ,Tuncayİ, Tosun N, Vural S. Ampütasyonlar: Nedenleri ve seviyeleri TurkishJournal Of ArthroplastyAndArthroscopicSurgery. 1999,2;179-83.
4. 4.Sümer A, Onur E,Altınlı A,Çelik A,Çağlayan K,Köksal N. Alt ekstremite ampütasyonlarında klinik deneyimlerimiz, İnönü üniversitesi tıp fakültesi dergisi 15 (3) 187-190 (2008)
5. 5.Mangano DT. Assesment of risk for cardiac and noncardiac surgical procedures. Anesthesiology Clinics of North America 1991;9(3):512-551.
6. 6. Masaki E, Takinami M, Kurata Y, Kagaya S, Ahmed A. Anestheticmanagement of high-risk cardiacpatientsundergoingnoncardiacsurgeryunderthesupport of intraaorticballoonpump. J ClinAnesth 1999;11(4):342- 345
7. 7. Eagle KA, Brundage BH, Chaitman BR, et al. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of theAmericanCollege of Cardiology/American Heart AssociationTask Force on PracticeGuidelines. Committee on Perioperative Cardiovascular Evaluation for NoncardiacSurgery. Circulation 1996;93(6):1278-1317.
8. 8. Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anesthesia: results from overview of randomised trials. BMJ 2000; 321: 1493-1497.

9. 9. Urwin SC, Parker MJ, Griffiths R. General versus regional anaesthesia for hip fracture surgery: a meta-analysis of randomized trials. Br J Anaesth 2000; 84: 450-4555.
10. 10. Casati A, Cappelleri G, Fanelli G, Borghi B, Anelati D, Berti M, et al. Regional anaesthesia for outpatient knee arthroscopy: a randomized clinical comparison of two different anaesthetic techniques. Acta Anaesthesiol Scand 2000;44(5):543-7. 12.
11. 11. Shih H, Hadzic A, Vloka JD, Koorn R, Brusco L, Thys DM. Non-Invasive, Real-time bioimpedance haemodynamic monitoring in patientsundergoinglow-levelspinalanaesthesia. Regionalanaesthesiaandpainmedicine 1998; vol 23 No. 3 May-JuneSupplement.
12. 12. Fanelli G, Casati A, Aldegheri G, Beccaria P, Berti M, Leoni A, et al. Cardiovascular effects of two different regional anaesthetic techniques for unilateral leg surgery. ActaAnaesthesiolScand. 1998;42:80–4.
13. 13. Naja Z, Hassan MJ, Khatib H, Ziade MF, Lonnqvist PA. Combined sciatic-paravertebral nerve block ve general anaesthesia for fractured hip of the elderly. Middle East J Anesthesiol 2000; 15: 559-568.
14. 14. Chia N, Low TC, Poon KH. Peripheral nerve blocks for lower limb surgery-A choice anaesthetic technique for patients with a recent myocardial infarction?. Singapore Med J 2002; 11: 583-586.
15. 15. Casati A, Grispigni C, Aldegheri G, et al. Peripheral or central nerve blocks for foot surgery: a prospective, randomized clinical comparison. Foot and Ankle Surgery 2002; 8: 95-98.