High Spinal Block for Cosmetic Mammoplasty and Liposculpture
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Autores: Celso S Nogueira, Pércio RBB Becker, José C Santos, Carlos R Degrandi Oliveira, Marcos H L Costa*, Gilberto W N Arenas.
Medcenter Unidade Cirúrgica e CET Santa Casa de Santos - Santos - SP Brazil
Background – Cosmetic Surgery is becoming increasingly common. Classic anesthetic techniques include general anesthesia, epidural block and spinal block under sedation. A high spinal block is an optional technique which has demonstrated comfort and security to our patients.
Cases Reports – We selected four patients that had been submitted for cosmetic surgery for: reduction mammoplasty, mastopexy with change of mammary implants, and liposuction in various parts of the body, including the arms and the thoracic area. Firstly, all the patients were clinically evaluated and informed about the anesthetic technique. After oral premedication with midazolam, the patients were monitored with cardioscopy, pulse oximetry and automatic non invasive blood pressure. Median spinal blocks were performed with the patients in a seated position, using a Whitacre needle between the L2-L3 interspace. The following drugs were administered: 20 mg of hyperbaric bupivacaine, 5 μg of sufentanil, and 2 μg.Kg-1 of clonidine. Immediately after the spinal puncture, the patients were placed in a lying down position with their legs raised by positioning the surgical bed to an angle of 30 degrees (this inclination allows the anesthetic to reach the upper thorax). The patients remained in this position for 15 minutes. Throughout the procedure, the patients maintained hemodynamic stability . Their blood pressure, heart rate and pulse oximetry remained stable. None of the patients complained of having difficulties in breathing or speaking, or of having shivering or cold sensations. All of them maintained full strength in their hands, arms, swallowing reflexes and capacity to move the head. After some hours in the recovery room, the patients were sent to the hospital ward.
Discussion – The simplicity of the spinal block, the use of known and safe drugs, and the hemodynamic and respiratory stability observed, all encourage the use of high spinal block for cosmetic and reconstructive thoracic procedures in plastic surgery.
Reference – Bush RL, Lin PH, Reddy PP et al - Epidural analgesia in patients with chronic obstructive pulmonary disease undergoing transperitoneal abdominal aortic aneurysmorraphy -a multi-institutional analysis. Cardiovasc Surg, 2003; 11:179-84.
Contato: celsonogueira@hotmail.com
Medcenter Unidade Cirúrgica e CET Santa Casa de Santos - Santos - SP Brazil
Background – Cosmetic Surgery is becoming increasingly common. Classic anesthetic techniques include general anesthesia, epidural block and spinal block under sedation. A high spinal block is an optional technique which has demonstrated comfort and security to our patients.
Cases Reports – We selected four patients that had been submitted for cosmetic surgery for: reduction mammoplasty, mastopexy with change of mammary implants, and liposuction in various parts of the body, including the arms and the thoracic area. Firstly, all the patients were clinically evaluated and informed about the anesthetic technique. After oral premedication with midazolam, the patients were monitored with cardioscopy, pulse oximetry and automatic non invasive blood pressure. Median spinal blocks were performed with the patients in a seated position, using a Whitacre needle between the L2-L3 interspace. The following drugs were administered: 20 mg of hyperbaric bupivacaine, 5 μg of sufentanil, and 2 μg.Kg-1 of clonidine. Immediately after the spinal puncture, the patients were placed in a lying down position with their legs raised by positioning the surgical bed to an angle of 30 degrees (this inclination allows the anesthetic to reach the upper thorax). The patients remained in this position for 15 minutes. Throughout the procedure, the patients maintained hemodynamic stability . Their blood pressure, heart rate and pulse oximetry remained stable. None of the patients complained of having difficulties in breathing or speaking, or of having shivering or cold sensations. All of them maintained full strength in their hands, arms, swallowing reflexes and capacity to move the head. After some hours in the recovery room, the patients were sent to the hospital ward.
Discussion – The simplicity of the spinal block, the use of known and safe drugs, and the hemodynamic and respiratory stability observed, all encourage the use of high spinal block for cosmetic and reconstructive thoracic procedures in plastic surgery.
Reference – Bush RL, Lin PH, Reddy PP et al - Epidural analgesia in patients with chronic obstructive pulmonary disease undergoing transperitoneal abdominal aortic aneurysmorraphy -a multi-institutional analysis. Cardiovasc Surg, 2003; 11:179-84.
Contato: celsonogueira@hotmail.com