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Abstract
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Background and Aims Diaphragmatic eventration, less commonly seen in adults, presents with paralysis, aplasia and diaphragmatic muscle fibers atrophy. Moreso, it´s associated with other respiratory pathologies, presenting challenges to anaesthetic management in order to minimize post-operative complications. We describe the successful anaesthetic management of a patient with diaphragmatic eventration.
Methods A 71 years-old male, ASA-PS IVE, with prior medical history of severe sleep apnea, left hemiparesis, metabolic syndrome and dementia. The patient was schedule for partial hip arthroplasty due to trauma. Prior to surgery, incidental radiological diagnosis of diaphragmatic eventration was made (figure 1). No further relevant alterations were found in analytical and transthoracic echocardiogram studies. A combined regional anaesthesia comprised of spinal block with 12,5mg levobupivacaine followed by an ultrasound guided suprainguinal fascia iliaca block (FICB) with 30mL of Ropivacaine 0,375% without conservatives.
Results The perioperative period was uneventful with no ventilatory support needed. In the first 24 hours the patient remained with mild pain, without the need for rescue opioid analgesia. The patient was discharged 5 days after procedure.
Conclusions Coexisting diaphragmatic and respiratory pathology increase the risk of post-operative respiratory complications associated with general anaesthesia, presenting a challenge to the Anaesthesiologist. In this clinical case, we demonstrate that a combined locoregional anaesthesia can be an effective and safe option. As such the FICB contribute to avoidance the use of opioids and respiratory depression as well as pulmonary complications related to mechanical ventilation. Locoregional anaesthesia constitutes a powerful weapon when approaching patients with complex respiratory pathology, contributing to minimizing post-operative morbidity and mortality.
Diaphragmatic eventration