Abstract

68 year-old female patient, with medical history of hypertension, treated with telmisartan/hydrochlorothiazide 80/12.5/24h. Minimal effort dyspnea, orthopnea, supine hypotension, bilateral  pleural  effusion,  pericardial  effusion,  heart  failure  with  left  ventricular  eyection  fraction (LVEF) of 20%, with very rapid evolution (2-3 months). Bilateral pleural effusions from  idiopathic  origin  (so  far).  She  was  scheduled  for  diagnostic  thoracoscopy,  pleural  effusion  drainage,  pericardial  window,  pleural  and  mediastinal  biopsies,  abrasive  and  chemical pleurodesis.

Anesthetic  plan:  Bilateral  erector  spinae  block  (ESP),  total  intravenous  anesthesia  with  remifentanyl using TCI Minto model and etomidate in target manual infussion (TMI).

Conclusions: Bilateral erector spinae block showed an opioid consumption (remifentanyl) decrease to half of regular doses. Also allowing an adecuate pain management during and after surgical procedure. There were no hemodynamic variations by the time of ESP block neither with the use of etomidate in induction and maintenance of anesthesia.

Keywords

bilateral erector spinae block, regional anesthesia, intravenous anesthesia, videothorascoscopy