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Ultrasound-guided peripheral nerve blocks, a safety method of anesthesia in patients with sepsis with an initial acute respiratory failure - presentation of two clinical cases

Petya Ivanova, Nikolay Mladenov, Deyan Anakievski, Viliyan Platikanov

Abstract

Anesthetic management of patients with severe sepsis is a great challenge. Systemic inflammation and acute organ dysfunction in response to infection is a major problem, especially respiratory failure and hemodynamic instability. Avoidance of lung injury during mechanical ventilation is possible with peripheral nerve blocks.

Clinical case 1: We present a 73-year-old male hemodialysis patient with sepsis. He had infectious complication of aneurysm formation of A-V fistula. The patient was hypoxic – SpO2 86-88%, with presence of tachypnea, RR-150/75, HR-125/min, Temp -380 C, coagulation abnormalities - INR 1, 58 (clopidogrel intake), elevated CRP and WBC.

The patient was indicated for emergency procedures of incision, drainage and ligation of A-V fistula. We performed supraclavicular brachial plexus block + sedation.

Clinical case 2: We present a 61-year-old woman with sepsis, with past medical history of diabetes, COPD, and endometrial cancer. She was with clinical presentation of necrotizing fasciitis of the upper extremity.

We performed ultrasound-guided supraclavicular brachial plexus block – ”in plane” technique, 30 mL/25 mL ropivacaine 0.5% in moderate sedated patients.

During the operation the patients were conscious, hemodynamically and respiratory stable, with oxygen supply by a mask, and with excellent intraoperative and postoperative pain control.

We think that ultrasound-guided peripheral nerve blocks are safe and effective alternatives for septic patients with/without coagulation abnormalities.


Keywords

US-guided peripheral nerve blocks, sepsis

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References

Eissa D, Carton EG, Buggy DJ. Anaesthetic management of patients with severe sepsis. Br J Anaesth. 2010;105(6):734-43. doi: 10.1093/bja/aeq305.

Fatungase OM Ogundipe AA Adebanjo AA. Usefulness of peripheral nerve block as an aneasthetic technique in a critically ill child – a case report. Niger J Paediatr. 2017; 44(1):39-41.

Kumar TS, Indu K, Parthasarathy S. Successful management of above knee amputation with combined and modified nerve blocks. Anesth Essays Res. 2017;11(2):520-51. doi:10.4103/0259-1162.183161.




DOI: http://dx.doi.org/10.14748/ssm.v51i3.5841

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About The Authors

Petya Ivanova
Medical University of Varna
Bulgaria

Clinic of Anesthesiology and Intensive Care, St. Marina University Hospital, Varna

Nikolay Mladenov
Medical University of Varna
Bulgaria

Clinic of Anesthesiology and Intensive Care, St. Marina University Hospital, Varna

Deyan Anakievski
Medical University of Varna
Bulgaria

Clinic of Urology, St. Marina University Hospital, Varna

Viliyan Platikanov
Medical University of Varna
Bulgaria

Clinic of Anesthesiology and Intensive Care, St. Marina University Hospital, Varna

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