[Total intravenous anesthesia for partial laryngectomy in 28 weeks pregnant patient: case report.].

BACKGROUND AND OBJECTIVES: Anesthesia for pregnant patients is a challenge to the anesthesiologist because of the risks for mother and fetus. There are many complications described by the literature, such as fetal malformations, premature birth, maternal hemodynamic instability and even fetal death. The objective here is to show a 28 weeks pregnant patient submitted to partial laryngectomy under total intravenous general anesthesia with propofol, remifentanil and cisatracurium.

CASE REPORT: Patient 29 years, 59 kg, primigravida of 28 weeks with previous diagnosis of epidermoid carcinoma close to the right vocal chord, scheduled for laryngectomy. Initial monitoring consisted of noninvasive and invasive blood pressure, cardioscopy, oxicapnography and continuous cardiotocography accomplished by the obstetrician. Venous puncture in right and left arm with 16G and 18G catheter, respectively. Patient received intravenous midazolam (1 mg), cefazolin (1 g), metoclopramide (10 mg) and dipirone (1 g). Patient was oxygenated with 100% O2 under mask for 3 minutes and intravenous anesthesia was induced with propofol in controlled target infusion (3 microg.mL-1) and continuous remifentanil (1 microg.kg-1 in bolus and 0.2 microg.kg-1.min-1 for maintenance). Cisatracurium (13 mg) was administered for muscle relaxation and tracheal intubation was achieved with 6.5 mm spiral-reinforced cuffed tube. Anesthesia was maintained with propofol and remifentanil in infusion pump, in addition to cisatracurium complementation. Fetus was continuously monitored with cardiotocography accomplished and analyzed by the obstetrician. Propofol and remifentanil infusion pumps were turned off at the end of completion and patient woke up 10 minutes later, without pain and hemodynamically stable, being then referred to the post-anesthetic care unit.

CONCLUSIONS: Total intravenous anesthesia with propofol and remifentanil has provided hemodynamic stability for mother and fetus, with early and smooth emergence.