Zupčić Miroslav, Korušić Anđelko, Barišin Stjepan, Peršec Jasminka, Nikolić Igor, Graf Zupčić Sandra, Jeleč Vjekoslav, Đuzel Viktor, Vlajčić Zlatko
Josip Juraj Strossmayer University of Osijek, Osijek School of Medicine, Dubrava University Hospital, Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Zagreb, Croatia.
Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Dubrava University Hospital, Zagreb, Croatia.
Acta Clin Croat. 2017 Dec;56(4):803-807. doi: 10.20471/acc.2017.56.04.31.
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.
在此，我们介绍两例通过剖腹术为患有恶性食管疾病的患者插入胃造口管的病例。患者的美国麻醉医师协会（ASA）身体状况分级为III级和IV级。这些患者被视为全身麻醉的极高风险患者，因此我们决定在四个胸段水平采用单侧左侧椎旁阻滞（PVB），并在胃造口管插入部位进行对侧局部浸润麻醉。我们展示两个病例，其中一例是一名57岁男性ASA III级患者，因食管癌侵犯气管而计划进行胃造口术。我们还展示了一例59岁男性患者，ASA IV级，因晚期食管癌伴有左主支气管与食管之间的瘘管以及左肺转移而计划进行相同手术。使用8赫兹（Hz）线性超声探头和神经刺激器来确定椎旁间隙。椎旁阻滞成功用于胃造口管的插入，从而实现了充分的麻醉和围手术期镇痛，且无血流动力学或呼吸并发症。
