ZNAČAJ UPOTREBE AKSILARNOG BLOKA KOD BOLESNIKA SA AMPUTIRANOM NADLAKTICOM I BROJNIM KOMORBIDITETIMA: PRIKAZ SLUČAJA
Sažetak
Operativni tretman osoba sa okluzivnom bolešću perifernih arterija ponekad predstavlja jedini terapijski pristup. S obzirom na to da izvođenje hirurške intervencije u opštoj endotrahealnoj anesteziji kod hemodinamski i respiratorno nestabilnog bolesnika ponekad predstavlja pravi izazov, primena neuraksijalnih blokova može biti pravi izbor.
Osamdesetogodišnji bolesnik je prevezen kao hitan slučaj na Odeljenje za kardiovaskularne bolesti Vojne bolnice u Nišu zbog otežanog disanja, blede leve šake i podlaktice. Izostajale su karpalne pulsacije, a u šaci bolesnika poslednjih nekoliko dana nije bilo motorike i senzibiliteta. Posle kliničkog pregleda i laboratorijskih analiza urađena je višeslojna kompjuterizovana tomografska angiografija plućnih i magistralnih arterija leve ruke, prilikom koje je postavljena dijagnoza plućne embolije i okluzije a. subclavia i a. brachialis. Nakon uvida u medicinsku dokumentaciju i kliničkog pregleda, anesteziolog se opredelio za neuraksijalnu anesteziju.
Izbegavanje opšte endotrahealne anestezije i primena neuraksijalnih blokova mogli bi minimalizovati mogućnost pojave neželjenih efekata kod bolesnika sa hemodinamskom i respiratornom nestabilnosti.
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