Limits...
Fascia Iliaca block as the sole anesthesia technique in a patient with recent myocardial infarction for emergency femoral thrombectomy.

Parate LH, Channappa NM, Pujari V, Iyer S - Saudi J Anaesth (2015 Apr-Jun)

Bottom Line: Acute limb ischemia is a surgical emergency that precludes prolonged preoperative cardiac evaluation.We discuss the perioperative anesthetic considerations in these case.Fascia iliaca block can be used as sole anesthesia technique for transfemoral thrombectomy in high-risk patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, M S Ramaiah Medical College, Bengaluru, Karnataka, India.

ABSTRACT
Acute limb ischemia is a surgical emergency that precludes prolonged preoperative cardiac evaluation. A 70-year-old female with recent myocardial infarction was posted for emergency transfemoral thrombectomy. We discuss the perioperative anesthetic considerations in these case. Fascia iliaca block can be used as sole anesthesia technique for transfemoral thrombectomy in high-risk patients.

No MeSH data available.


Related in: MedlinePlus

Fascia Iliaca block (ST: Subcutaneous tissue, FL: Fascia Lata, FI: Fascia Iliaca)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4374228&req=5

Figure 1: Fascia Iliaca block (ST: Subcutaneous tissue, FL: Fascia Lata, FI: Fascia Iliaca)

Mentions: Patient was positioned supine with 15° head up tilt. Oxygen 5 l/min was given via face mask. Cardiac resuscitation drugs and equipments were kept ready. Routine monitors (five lead ECG, SpO2, temperature) were attached. Arterial canula was inserted in left radial artery and right internal jugular vein was cannulated for invasive monitoring. Right sided FIB was performed under ultrasound guidance. Under all aseptic precaution, local infiltration to skin was done. A linear probe was used to identify femoral artery, iliacus muscle and fascia iliaca. A 22 G 100 mm needle (Stimuplex®; B. Braun, Melsungen, Germany) needle was inserted in-plane and was positioned below fascia iliaca [Figure 1]. Tip of needle position was confirmed by giving 2cc of drug that showed drug deposition below fascia iliaca. 40cc of 0.375% ropivacaine was given and proper spread of drug was confirmed. After 20 min sensory block was tested with 20 G hypodermic needle over anterior, medial and lateral aspect of thigh. Motor block for femoral nerve was assessed by examining knee extension. There was a complete loss of sensation over entire anterior aspect of thigh and adequate motor block was achieved. Patient was sedated with intravenous (IV) dexmedetomidine 0.5 mcg/kg bolus over 10 min, followed by an infusion of 0.5 mcg/kg/h for the duration of the surgery. She was kept warm by active warming blanket. Femoral arteriotomy was done, and thrombus was removed [Figure 2]. She lost around 500cc of blood that was replaced with blood. Her intraoperative hemodynamics was stable, and SpO2 remained above 94%. The duration of surgery was 2 h. She was shifted to cardiac care unit. On 2nd postoperative day patient developed supraventricular tachycardia that was reverted with IV amiodarone. Her postoperative course was uneventful. She was discharged home after 15 days.


Fascia Iliaca block as the sole anesthesia technique in a patient with recent myocardial infarction for emergency femoral thrombectomy.

Parate LH, Channappa NM, Pujari V, Iyer S - Saudi J Anaesth (2015 Apr-Jun)

Fascia Iliaca block (ST: Subcutaneous tissue, FL: Fascia Lata, FI: Fascia Iliaca)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374228&req=5

Figure 1: Fascia Iliaca block (ST: Subcutaneous tissue, FL: Fascia Lata, FI: Fascia Iliaca)
Mentions: Patient was positioned supine with 15° head up tilt. Oxygen 5 l/min was given via face mask. Cardiac resuscitation drugs and equipments were kept ready. Routine monitors (five lead ECG, SpO2, temperature) were attached. Arterial canula was inserted in left radial artery and right internal jugular vein was cannulated for invasive monitoring. Right sided FIB was performed under ultrasound guidance. Under all aseptic precaution, local infiltration to skin was done. A linear probe was used to identify femoral artery, iliacus muscle and fascia iliaca. A 22 G 100 mm needle (Stimuplex®; B. Braun, Melsungen, Germany) needle was inserted in-plane and was positioned below fascia iliaca [Figure 1]. Tip of needle position was confirmed by giving 2cc of drug that showed drug deposition below fascia iliaca. 40cc of 0.375% ropivacaine was given and proper spread of drug was confirmed. After 20 min sensory block was tested with 20 G hypodermic needle over anterior, medial and lateral aspect of thigh. Motor block for femoral nerve was assessed by examining knee extension. There was a complete loss of sensation over entire anterior aspect of thigh and adequate motor block was achieved. Patient was sedated with intravenous (IV) dexmedetomidine 0.5 mcg/kg bolus over 10 min, followed by an infusion of 0.5 mcg/kg/h for the duration of the surgery. She was kept warm by active warming blanket. Femoral arteriotomy was done, and thrombus was removed [Figure 2]. She lost around 500cc of blood that was replaced with blood. Her intraoperative hemodynamics was stable, and SpO2 remained above 94%. The duration of surgery was 2 h. She was shifted to cardiac care unit. On 2nd postoperative day patient developed supraventricular tachycardia that was reverted with IV amiodarone. Her postoperative course was uneventful. She was discharged home after 15 days.

Bottom Line: Acute limb ischemia is a surgical emergency that precludes prolonged preoperative cardiac evaluation.We discuss the perioperative anesthetic considerations in these case.Fascia iliaca block can be used as sole anesthesia technique for transfemoral thrombectomy in high-risk patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, M S Ramaiah Medical College, Bengaluru, Karnataka, India.

ABSTRACT
Acute limb ischemia is a surgical emergency that precludes prolonged preoperative cardiac evaluation. A 70-year-old female with recent myocardial infarction was posted for emergency transfemoral thrombectomy. We discuss the perioperative anesthetic considerations in these case. Fascia iliaca block can be used as sole anesthesia technique for transfemoral thrombectomy in high-risk patients.

No MeSH data available.


Related in: MedlinePlus