Abstract

SPINAL ANESTHESIA FOR TRANSURETHRAL RESECTION OF A BLADDER TUMOR IN A PATIENT WITH PULMONARY HYPERTENSION AND SEVERE MITRAL REGURGITATION. CASE REPORT

Siddharta Lacerda – MD, *Luiz Eduardo Imbelloni – MD, PhD and Alexandre da Silva Andrade - MD

ABSTRACT

This case presents a 99-year-old man with severe pulmonary hypertension, severe mitral regurgitation with a significant increase in the left atrium, type III diastolic dysfunction of the left ventricle, aortic biological prosthesis and marks a definitive cardiac pace, mild chronic obstructive pulmonary disease who presents with urinary obstruction due to bladder tumor. Spinal anesthesia was associated with decreased recurrence rate and extended recurrence-free survival compared to general anesthesia. The objective of this case is to report the use spinal anesthesia in two procedures for TURBT despite the indication by the cardiologist and pulmonologist to perform the procedure on local anesthesia with low dose of 0.5% isobaric bupivacaine and sedation. The decision of the anesthetic technique to be used on any patient must be the decision of the anesthetist. An individualized and optimized approach leads to better results, quality of recovery and patient satisfaction. Despite the clinical indications, this patient was successfully operated with two procedures on spinal anesthesia with an interval of 16 hours between them.

Keywords: Bladder tumor, Urinary retention, Geriatrics, Comorbidity, Spinal anesthesia, Perioperative care, Urologic surgery.