Erector spinae block and total intravenous anesthesia for videothoracoscopy in a patient with heart failure
- International Journal of Family & Community Medicine
Aguirre-Castro GD,1 Rendón-Mendivil JP,2 Estrada-Montaño DA,3 Terreros-Montanchez A P,4 Franco-Garza M5
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68 year-old female patient, with medical history of hypertension, treated with telmisartan/hydrochlorothiazide 80/12.5/24h. Minimal effort dyspnea, orthopnea, supine hypotension, bilateral pleural effusion, pericardial effusion, heart failure with left ventricular eyection fraction (LVEF) of 20%, with very rapid evolution (2-3 months). Bilateral pleural effusions from idiopathic origin (so far). She was scheduled for diagnostic thoracoscopy, pleural effusion drainage, pericardial window, pleural and mediastinal biopsies, abrasive and chemical pleurodesis.
Anesthetic plan: Bilateral erector spinae block (ESP), total intravenous anesthesia with remifentanyl using TCI Minto model and etomidate in target manual infussion (TMI).
Conclusions: Bilateral erector spinae block showed an opioid consumption (remifentanyl) decrease to half of regular doses. Also allowing an adecuate pain management during and after surgical procedure. There were no hemodynamic variations by the time of ESP block neither with the use of etomidate in induction and maintenance of anesthesia.
bilateral erector spinae block, regional anesthesia, intravenous anesthesia, videothorascoscopy