Perioperative Challenges of Heroin Addiction: A Case Report of Opioid-Free Anesthesia in Tongue Carcinoma Excision With Free-Flap Reconstruction.
| Autor: | Ameiro RJ; Department of Anaesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT., Neves SS; Department of Anaesthesiology, Centro Hospitalar Universitário de Santo António, Porto, PRT., Oliveira RP; Department of Anaesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT., Marques BB; Department of Anaesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT., Ferreira PC; Department of Anaesthesiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2023 Jun 30; Vol. 15 (6), pp. e41195. Date of Electronic Publication: 2023 Jun 30 (Print Publication: 2023). |
| DOI: | 10.7759/cureus.41195 |
| Abstrakt: | Anesthesia for major head and neck surgery is historically heavily reliant on opioids with deleterious consequences. We reported a case of a patient with a history of heroin abuse submitted to a tongue carcinoma excision, followed by free-flap reconstruction under opioid-free anesthesia. We used a propofol total intravenous anesthesia and perfusions of ketamine, dexmedetomidine, lidocaine, and magnesium sulfate for analgesia, complemented by boluses of dexamethasone, acetaminophen, parecoxib, and metamizole. Hemodynamic needs of the procedure were addressed by titrating perfusions of sodium nitroprusside or dobutamine. The patient was weaned from the ventilator at the end of the surgery. Surgical outcomes were achieved and opioid-free analgesia allowed early reestablishment of bodily functions without compromise of adequate pain control. Anesthesia protocols for free-flap surgery still lack scientific evidence, especially in the context of substance abuse: opioid-sparing approaches seem a viable option, which requires further studies and familiarity by health care professionals. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2023, Ameiro et al.) |
| Databáze: | MEDLINE |
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