title: [Ultrasound-guided rectus sheath blockade is a safe and accurate method for emergency ileostomy for patients with coagulopathy].
abstract: Obstructive ileus is a life-threatening gastrointestinal condition that requires emergency operation. Patients with obstructive ileus sometimes develop coagulopathy. In such cases, central neuraxial blockade should be avoided. Rectus sheath blockade (RSB) is one of the popular methods for abdominal wall surgery. Ultrasound imaging of the rectus sheath may facilitate successful RSB by indicating the presence and location of rectus abdominis. Two patients presented with ileus secondary to rectal or sigmoid cancer and underwent emergency ileostomy. The patients had mild coagulopathy [platelet count, 77,000 microl(-1) in case 1, and platelet count, 98,000 microl(-1) in case 2]. Each patient underwent general anesthesia using propofol and remifentanil. They were given 0.5% ropivacaine 20ml for RSB under ultrasound-guidance. Their hemodynamics was stable and they did not need another muscle relaxant during operation, except succinylcholine during induction. RSB is useful for abdominal operations. In addition, ultrasonogrhaphy facilitates the prediction of depth of the posterior rectus sheath and improves the accuracy of local anesthetic placement. We conclude that RSB is effective for improving postoperative pain and intraoperative muscle relaxation of the abdominal wall. Ultrasound-guided RSB is an alternative method to central neuraxial blockade.
authors: Department of Anesthesiology, Kitasato Institute Hospital, Kitasato University, Tokyo 108-8642.
authors: Yoshimune
authors: Y
authors: Osaka
authors: Masanori
authors: M
authors: Kashiwagi
authors: Yukio
authors: Y
authors: Nagatsuka
authors: Sakurako
authors: S
authors: Miwa
mesh_terms: D000369:Aged, 80 and over; D000768:Anesthesia, General; D001778:Blood Coagulation Disorders / Q000209:etiology*; D004630:Emergencies; D005260:Female; D006801:Humans; D007081:Ileostomy; D045823:Ileus / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D008297:Male; D009407:Nerve Block / Q000379:methods*; D019990:Perioperative Care; D010880:Piperidines; D015742:Propofol; D012004:Rectal Neoplasms / Q000150:complications; D017568:Rectus Abdominis / Q000000981:diagnostic imaging* / Q000601:surgery*; D000077208:Remifentanil; D012811:Sigmoid Neoplasms / Q000150:complications; D014463:Ultrasonography
chemical_list: D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol