Mielinolisis pontina central e hiponatremia perioperatoria: particularidades en la cirugía de trasplante hepático

Karina  Rando; Marcelo Valverde; José María Menéndez; Paola Scalone; Solange Gerona; Gustavo Greco; Jorge Castelli

doi:10.35954/SM2013.32.1.6

Autores

Karina Rando Anestesista na Unidade Bi-Institucional de Transplante de Fígado e no Centro Nacional Hepato-Bilio-Pancreático (UDA), Hospital Militar. Ex-professor Adjunto de Anestesiologia, professor de Mestrado em Anestesiologia e Engenharia Biomédica, Faculdades de Medicina, Engenharia e Medicina Veterinária - Universidade da República, Montevidéu - Uruguai. https://orcid.org/0000-0001-7397-1711
Marcelo Valverde Unidade Bi-Institucional de Doenças Hepáticas Complexas (Hospital Militar, Hospital de Clínicas), Programa de Transplante de Fígado.
José María Menéndez Unidade Bi-Institucional de Doenças Hepáticas Complexas (Hospital Militar, Hospital de Clínicas), Programa de Transplante de Fígado.
Paola Scalone Unidade Bi-Institucional de Doenças Hepáticas Complexas (Hospital Militar, Hospital de Clínicas), Programa de Transplante de Fígado.
Solange Gerona Unidade Bi-Institucional de Doenças Hepáticas Complexas (Hospital Militar, Hospital de Clínicas), Programa de Transplante de Fígado.
Gustavo Greco Unidade Bi-Institucional de Doenças Hepáticas Complexas (Hospital Militar, Hospital de Clínicas), Programa de Transplante de Fígado.
Jorge Castelli Unidade Bi-Institucional de Transplante de Fígado e no Centro Nacional Hepato-Bilio-Pancreático (UDA), Hospital Militar. https://orcid.org/0000-0002-9086-4915

DOI:

https://doi.org/10.35954/SM2013.32.1.6

Palavras-chave:

Anestesia; Desmielinização; Hiponatremia; Mielinólise Pontina Central; Cuidados Intensivos.

Resumo

A mielinólise pontina central (CPM) ou mielinólise pontina central (CPM) é uma doença neurológica rara que pode levar a seqüelas neurológicas graves e permanentes ou mesmo à morte. Ela resulta na desmielinização dos pons e em 10% dos pacientes afeta áreas extrapontinas e é conhecida como síndrome de desmielinização osmótica ou desmielinização extra pontina (EPD). Os pacientes cirróticos e aqueles submetidos a transplante hepático correm alto risco de desenvolver PCM e SPD. Na maioria das vezes é causada pela correção rápida e inadequada da hiponatraemia, mas também pode ocorrer com soro de sódio basal normal ou mesmo aumentado. Intraoperatoriamente em grandes cirurgias (como transplante de fígado), a perda de sangue pode requerer a administração de vários litros de soluções com osmolaridade normal. Se o paciente tiver hiponatraemia pré-operatória, é gerado um forte aumento no sódio plasmático que pode causar MCP. Entretanto, há outros fatores independentes do sódio que podem levar a esta condição que também serão discutidos nesta revisão.

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