Anestesia no paciente com derrame pericárdico

um caso incomum de pericardite efusiva-constritiva

Abstract

Introduction:Tuberculosis is still an extremely prevalent disease in Brazil. Its spectrum of involvement can range from asymptomatic individuals to severe cases with relevant sequelae, which can directly impact the outcome of the anestheticsurgical act. Objective: The aim of this paper is to report a rare case of a young patient, but with severe cardiovascular manifestations of tuberculosis, due to involvement of the pericardium, evolving with effusive-constrictive pericarditis and important intraoperative hemodynamic instability, after general anesthesia. Methodology: Descriptive, observational crosssectional research (case report). Discussion: This report focused on the consequences of effusive-constrictive pericarditis in the conduction of anesthesia (level of hemodynamic monitoring, type of anesthetic technique and vasoactive drugs), as well as the care that the team should have in the face of a patient with this condition, aiming to reduce morbidity and mortality.
Anesthetic agents such as ketamine and nitrous oxide appear to be safer drugs in hemodynamically critical patients. In cases of tamponade, these patients may benefit from pericardial puncture
before anesthetic induction. In these cases, vasoactive and inotropic drugs can be used to modulate the cardiodepressant effects of anesthetic agentes. Conclusion: Effusive-constrictive pericarditis can prove to be an extremely challenging condition, especially in young patients with severe and adapted symptoms. It is extremely important to carefully assess the patient, in addition to aligning the correct choice of anesthetic agents with hemodynamic goals, anticipating critical situations and, thus, obtaining more favorable results.