Soulioti Eleftheria D, Antonopoulos Dimitrios G, Manikis Dimitrios E, Kakisis Ioannis D, Matsota Paraskevi K
2nd Department of Anesthesiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC.
2nd Department of Vascular Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC.
Cureus. 2023 Aug 16;15(8):e43605. doi: 10.7759/cureus.43605. eCollection 2023 Aug.
We present the first documented case of achieving surgical anesthesia for a vascular surgery using the suprainguinal approach of the fascia iliaca compartment block (SFICB), in a patient with severe comorbidities from the cardiovascular system. More specifically, a male elderly patient with a history of cardiac amyloidosis, severe aortic stenosis, and coronary artery disease, was in need of emergent thrombectomy due to acute lower limb ischemia. During the evaluation of this patient, general and neuraxial anesthesia were both considered. However, the former would expose him to the risk of myocardial ischemia and other complications due to cardiovascular instability caused by the general anesthetic agents while the latter was absolutely contraindicated due to recent clopidogrel use and the specific pathophysiology changes induced by cardiac amyloidosis. Thus, a peripheral nerve block was deemed to be the best option in this case. SFICB, despite being challenging, could offer adequate analgesic results so it was the anesthetic technique of choice. The surgery was completed and the patient recovered appropriately. The aim of this report is to discuss the specific anesthetic considerations of this case, highlight the ability of SFICB to achieve surgical anesthesia in vascular surgeries, and increase familiarity with the procedure.
我们报告了首例记录在案的、采用髂筋膜间隙阻滞（SFICB）的腹股沟上入路为一名患有严重心血管系统合并症的患者进行血管手术实现外科麻醉的病例。具体而言，一名有心脏淀粉样变性、严重主动脉瓣狭窄和冠状动脉疾病病史的老年男性患者，因急性下肢缺血需要紧急进行血栓切除术。在对该患者进行评估时，全身麻醉和神经轴麻醉均被考虑。然而，前者会因全身麻醉药物导致的心血管不稳定，使他面临心肌缺血和其他并发症的风险，而后者由于近期使用氯吡格雷以及心脏淀粉样变性引起的特定病理生理变化而绝对禁忌。因此，在这种情况下，外周神经阻滞被认为是最佳选择。尽管SFICB具有挑战性，但它能提供足够的镇痛效果，所以它是首选的麻醉技术。手术顺利完成，患者恢复良好。本报告的目的是讨论该病例的具体麻醉注意事项，强调SFICB在血管手术中实现外科麻醉的能力，并增加对该手术的熟悉程度。
