Torakotomia w znieczuleniu zewnątrzoponowym u przytomnego chorego – opis przypadku

Hanna Misiołek¹, Hanna Kucia¹, Magdalena Werszner¹, Piotr Knapik, Jacek Gawrychowski²

Summary
Background. Although many surgical procedures are nowadays being performed under regional anaesthesia (RA) alone, it is rather unusual to open the chest wall in a conscious patient. We present a case, when serious contraindications to general anaesthesia forced us to perform the surgery under RA in a patient with a lung tumour. Case report. A 43-yr-old male patient, with a documented history of allergy to most intravenous anaesthetics and muscle relaxants, was scheduled for thoracotomy for a left lower lobe lung tumour. An epidural catheter was introduced via the Th₄-Th₅ interspace and 12 ml of 0.5% bupivacaine with 100 mcg of fentanyl was injected. This resulted in effective analgesia extending from Th₂ to Th₉. Thiopentone 2 mg kg^-1 was given for sedation while the patient breathed spontaneously via a face oxygen mask. A Hamartoma tumour was excised via a small thoracotomy without complication. The postoperative course was uneventful. Discussion and conclusion. Allergic reactions to anaesthetic agents, although rare, may be fatal. In patients with a documented history, RA is a logical choice. High thoracic epidural analgesia has been described for thoracotomy in a selected case, and can be recommended for similar cases.

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