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.
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