Acta clinica Croatica, Vol. 56. No. 4., 2017.
Other
https://doi.org/10.20471/acc.2017.56.04.31
Gastrostomy Under Paravertebral Block in High-Risk Patients with Esophageal Cancer – Two Case Reports
Miroslav Zupčić
; Josip Juraj Strossmayer University of Osijek, Osijek School of Medicine, Dubrava University Hospital, Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Zagreb, Croatia
Anđelko Korušić
; Josip Juraj Strossmayer University of Osijek, Osijek School of Medicine, Dubrava University Hospital, Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Zagreb, Croatia
Stjepan Barišin
; Josip Juraj Strossmayer University of Osijek, Osijek School of Medicine, Dubrava University Hospital, Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Zagreb, Croatia
Jasminka Peršec
; Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Dubrava University Hospital, Zagreb, Croatia
Igor Nikolić
; Josip Juraj Strossmayer University of Osijek, Osijek School of Medicine, Dubrava University Hospital, Clinical Department of Surgery, Zagreb, Croatia
Sandra Graf Zupčić
; Josip Juraj Strossmayer University of Osijek, Sveti Duh University Hospital, Clinical Department of Neurology, Zagreb, Croatia
Vjekoslav Jeleč
; Josip Juraj Strossmayer University of Osijek, Osijek School of Medicine, Dubrava University Hospital, Department of Neurosurgery, Zagreb, Croatia
Viktor Đuzel
; Barking, Havering and Redbridge University Hospitals NHS Trust, Department of Anaesthesia, London, United Kingdom
Zlatko Vlajčić
; Josip Juraj Strossmayer University of Osijek, Osijek School of Medicine, Dubrava University Hospital, Clinical Department of Plastic, Reconstructive and Aesthetic Surgery, Zagreb, Croatia
Abstract
Here we present two cases of gastrostomy insertion via laparotomy in patients with malignant esophageal disease. Patients were ASA (American Society of Anesthesiologists) physical status III and IV. The patients presented as very high risk for general anesthesia, so we decided to use unilateral left sided paravertebral block (PVB) on four thoracic levels along with contralateral local infiltration at the gastrostomy insertion site. We present two cases, one of them a 57-year-old male ASA III patient scheduled for a gastrostomy procedure due to esophageal cancer with infiltration of the trachea. We also present a case of a 59-year-old male patient, ASA IV status, scheduled for the same procedure due to advanced esophageal cancer with a fistula between the left main bronchus and the esophagus and metastases in the left lung. The paravertebral space was identified with the use of an 8 Hertz (Hz) linear ultrasound probe and a nerve stimulator. Paravertebral block was successfully used for insertion of a gastrostomy, thereby enabling adequate anesthesia and perioperative analgesia without hemodynamic or respiratory complications.
Keywords
Local anesthetics; Anesthesia; Analgesia; Gastrostomy; Esophageal cancer
Hrčak ID:
195541
URI
Publication date:
15.12.2017.
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