Ultrasound-guided peripheral nerve blocks, a safety method of anesthesia in patients with sepsis with an initial acute respiratory failure - presentation of two clinical cases

Abstract

Anesthetic management of patients with severe sepsis is a great challenge. Systemic inflammation and acute organ dysfunction in response to infection is a major problem, especially respiratory failure and hemodynamic instability. Avoidance of lung injury during mechanical ventilation is possible with peripheral nerve blocks. Clinical case 1 : We present a 73-year-old male hemodialysis patient with sepsis. He had infectious complication of aneurysm formation of A-V fistula. The patient was hypoxic – SpO 2 86-88%, with presence of tachypnea, RR-150/75, HR-125/min, Temp -38 0 C, coagulation abnormalities - INR 1, 58 (clopidogrel intake), elevated CRP and WBC. The patient was indicated for emergency procedures of incision, drainage and ligation of A-V fistula. We performed supraclavicular brachial plexus block + sedation. Clinical case 2 : We present a 61-year-old woman with sepsis, with past medical history of diabetes, COPD, and endometrial cancer. She was with clinical presentation of necrotizing fasciitis of the upper extremity. We performed ultrasound-guided supraclavicular brachial plexus block – ”in plane” technique, 30 mL/25 mL ropivacaine 0.5% in moderate sedated patients. During the operation the patients were conscious, hemodynamically and respiratory stable, with oxygen supply by a mask, and with excellent intraoperative and postoperative pain control. We think that ultrasound-guided peripheral nerve blocks are safe and effective alternatives for septic patients with/without coagulation abnormalities.