Anestesia Subaracnoidea com Bupivacaína Associada à Clonidina em Paciente Usuário de Cocaína: Relato de Caso

Spinal Anesthesia with Bupivacaine Associated to Clonidine in Cocaine User Patient: Case Report

Abstract

Cocaine is one of the illicit drugs most commonly used in the world, whose users might be submitted to emergency surgical interventions. Both general and local anesthesia presents risks to the patient, so the objective of this report is to describe the use of clonidine in spinal anesthesia in a patient with recent use of cocaine. Male patient, 24 years, 75 kg, 1.75 m, ASA I physical status, was admitted to emergency hospital and submitted to mechanical-surgical cleansing and external fixation of the open right tibial fracture. He was monitored with continuous electrocardiogram (EKG), non-invasive blood pressure measure, pulse oximetry, observing heart rate (HR) levels of 115 bpm, blood pressure (BP) 160x90 mmHg and SpO2 97%, being subjected to spinal anesthesia under standard technique with 0,5% hyperbaric bupivacaine (15mg) and clonidine (75mcg). After the beginning of the procedure, it was noticed a decrease of the patient anxiety levels and constant variation of the hemodynamic state during the first 30 minutes with improvement during surgery. At the end of the procedure, the patient was transferred to hemodynamically stable Post-anesthesia care unit. The increase of HR, BP and systemic vascular resistance related to the blockage of norepinephrine release from presynaptic terminals caused by cocaine, can be treated with alpha-2 adrenergic agonist such as clonidine, as seen in this report.