There’re many benetits of using regional anesthesia(RA) but sometimes performing RA compared to general anesthesia(GA) has some life saving advantages. I would like to share one of our experiance.
51-year-old male patient presented with multiple rib, tibial and scaphoid fractures due to fall from tractor and planned for external fixation. He was 180 cm tall, weighed 120 kg, had a history of obstructive sleep apnea (OSA) and 60 pack-year of smoking. He wasn’t operated before, not on any medications, not allergic to drug and didn’t use cpap or oral device for osas.
He was found conscious, pulse rate(PR) 88/min, blood pressure(BP) 160/80mmHg and SpO2 94. Airway investigation revealed mallampati score 3, mouth opening 4cm, thyromental distance 6cm and neck circumference 52cm. He had 6 score in El-Ganzouri airway difficulty score, 35 points in Ariscat score and 6 points in Stop-Bang score. His high scores implied he could suffer from pulmonary complications periopereatively and we might encounter difficulties with his airway protection. To avoid such problems, infraclavicular block with 20 ml of prilocain 2%+bupivacain 0.5% and spinal anesthesia with 1.8 ml of 0.5% hyperbaric bupivacain were performed for his tibial and scaphoid fractures while avoiding sedatives and opioids. Surgery lasted 130 minutes uneventfully and without any complaints from patient who was sent to orthopedics ward.
Patients with OSA are at increased risk of perioperative morbidity and mortality because of potential difficulty in maintaining a patent airway.1Patients have increased perioperative risk from OSA and are prone to respiratory and airway problems if opioids, sedatives and inhaled anesthetics are used.1 RA for a difficult airway patient helps avoiding difficulty of awake fiberoptic intubation and bypasses the question of when and where to extubate the patient.2 RA is recommended in patients with OSA and/or potentially difficult airways who present for surgery.1 3
American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea An Updated Report by the American Society of Anesthesiologists Task Force on Perioperative Management of Patients with Obstructive Sleep Apnea. Anesthesiology, 2014 Feb;120(2):268–86.
Slade IR, Samet RE. Regional Anesthesia and Analgesia for Acute Trauma Patients. Anesthesiol Clin, 2018 Sep;36(3):431–454.
Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task force on management of the difficult airway. Anesthesiology 2013;118:251–70.
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