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Case Report
Total intravenous anesthesia in a patient with Poland syndrome submitted to video-laparoscopic inguinal hernioplasty: A case report
1 MD, General Surgery Resident, Federal University of Maranhão–UFMA, Av Colares Moreira n 48, Ed Leblonapto 501 Jardim Renascença, Brazil
2 MD, MS, Federal University of Maranhão–UFMA, Avenida dos Holandeses, 11, Torre 6, Apartment 13, Condomínio Farol da Ilha, São Luís, MA, Brazil
3 Medical Student, Federal University of Maranhão–UFMA, Rua 1, Planalto Vinhais 1, Condomínio Búzios, 29, Brazil
4 Medical Student, Federal University of Maranhão–UFMA, RuaItaparica, Tropical Condominium II, Block G, Apartment 302, Cohama, Sao Luis, MA, Brazil
5 MD, PhD, Professor of Federal University of Maranhão–UFMA, Rua Turiaçu 800, Horizonte Residence Building, Apartment 800, Renaissance Garden, Brazil
6 MD, PhD, Professor of Federal University of Maranhão–UFMA, 12 Parnaiba Street, 900 SR Apartment, Casa do Morro Condominium, Brazil
7 MD, PhD, Professor of Federal University of Maranhão–UFMA, Rua das Boninas 130, Block A2, Apartment 302, Ile Saint Louis Condominium, Ponta da Areia, Sao Luis, MA, Brazil
8 MD, PhD, Professor of Federal University of Maranhão–UFMA, Rua das Boninas 130, Block B2, Apartment 1202, Ile Saint Louis Condominium, Ponta da Areia, Sao Luis, MA, Brazil
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Plinio da Cunha Leal
Rua das Boninas 130, Block B2, Apartment 1202, Ile Saint Louis Condominium, Ponta da Areia, Sao Luis, MA, Zip Code: 65077-552,
Brazil
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Article ID: 101163Z01RR2020
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Rodrigues RF, de Lima RC, Rayol GA, de Oliveira EJSG, Moura ECR, de Oliveira CMB, de Sousa Gomes LMR, da Cunha Leal P. Total intravenous anesthesia in a patient with Poland syndrome submitted to video-laparoscopic inguinal hernioplasty: A case report. Int J Case Rep Images 2020;11:101163Z01RR2020.ABSTRACT
Introduction: Poland syndrome (PS) is a rare disease characterized by hypoplasia/agenesis of the pectoralis major muscle, associated ipsilateral upper limb abnormalities and/or thoracic abnormalities. Few cases of patients with PS have been reported in the literature, and a detailed description of the anesthetic management of these patients is scarce. Poland syndrome imposes specific anesthetic conducts to avoid complications related to the degree of thoracic wall deformity and the possibility of malignant hyperthermia (MH) due to the use of succinylcholine and some inhaled anesthetics.
Case Report: We report the anesthetic management of a patient diagnosed with PS submitted to video-laparoscopic hernioplasty by total intravenous anesthesia with invasive ventilation. The patient presented absence of the left pectoral muscles, besides ipsilateral syndactyly. We performed monitorization with non-invasive blood pressure, pulse oximetry, esophageal thermometer, capnography, and electrocardiogram. The anesthetic technique was total intravenous anesthesia. Induction with propofol, fentanyl, cisatracurium, followed by maintenance with propofol target-controlled infusion guided by bispectral index (BIS). At the end of the procedure, tenoxicam, dipyrone, dexamethasone, and ondansetron were administered, besides atropine and neostigmine for reversal of neuromuscular blockade.
Conclusion: The PS imposes specific anesthetic management and adequate monitorization to avoid complications related to the chest deformity. The anesthetic technique was total intravenous anesthesia to reduce the doses used and also it was performed in a context to avoid MH.
Keywords: Anesthesia, Case reports, Perioperative care, Poland syndrome
SUPPORTING INFORMATION
Author Contributions
Rayssa Fiterman Rodrigues - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Roclides Castro de Lima - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guilherme Araujo Rayol - Acquisition of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Eduardo José Silva Gomes de Oliveira - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ed Carlos Rey Moura - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Caio Marcio Barros de Oliveira - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Lyvia Maria Rodrigue de Sousa Gomes - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Plinio da Cunha Leal - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Rayssa Fiterman Rodrigues et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
