Abstract
Purpose
Patients with hypertrophic obstructive cardiomyopathy (HOCM), agenetic disorder resulting in idiopathic myocardial thickening, can present the anesthesiologist with significant management difficulties. This report reviews the physiology of this important disease process and describes the use of paravertebral nerve blocks (PVB) in the management of a patient with HOCM who presented for partial mastectomy with axillary lymph node dissection.
Clinical features
A 72-yr-old female presented for breast cancer surgery with a significant past medical history of HOCM diagnosed during hospitalization for non-small cell lung cancer. PVB were performed at thoracic levels 1–6 and 5 mL of 0.5% ropivacaine and epinephrine 1:400,000 was injected at each level. Intraoperatively the patient required no other medication for analgesia and was comfortable and conversant during the two-hour procedure. She remained pain free following the operation and did not require any opioid medication until the following day.
Conclusions
PVB provide excellent analgesia and are a useful alternative anesthetic when faced with the HOCM patient requiring major breast surgery.
Résumé
Objectif
La prise en charge anesthésique de patients atteints de cardiomyopathie obstructive (CMO), affection génétique causant une hypertrophie myocardique idiopathique, peut comporter de grandes difficultés. Le présent article passe en revue la physiologie de cet important processus morbide et décrit l’usage de blocage nerveux paravertebral (BPV) chez une patiente atteinte d’une CMO devant subir une mastectomie partielle avec évidement ganglionnaire axillaire.
Eléments cliniques
Une femme de 72 ans, devant être opérée pour un cancer du sein, avait des antécédents importants de CMO diagnostiquée pendant une hospitalisation pour cancer bronchopulmonaire “non à petites cellules”. Lanesthésie a été réalisée par BPV aux niveaux thoraciques 1–6, une injection de 5 mL de ropivacaïne à 0,5 % et d’épinéphrine à 1:400 000 a été faite à chaque niveau. Pendant l’intervention de deux heures, la patiente n’a pas demandé d’autre analgésique, elle se sentait bien et pouvait converser. Elle n’a pas eu de douleur postopératoire et n’a eu besoin d’opioïde que le jour suivant.
Conclusion
Les BPV procurent une excellente analgésie et sont une variante efficace dans les cas de CMO nécessitant une intervention mammaire importante.
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Buckenmaier, C.C., Steele, S.M., Nielsen, K.C. et al. Paravertebral somatic nerve blocks for breast surgery in a patient with hypertrophic obstructive cardiomyopathy. Can J Anesth 49, 571–574 (2002). https://doi.org/10.1007/BF03017383
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DOI: https://doi.org/10.1007/BF03017383