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Journal Latinoamericano de Medicina Veterinaria de Emergencia y Cuidados
Intensivos
Sndrome Compartimental Abdominal em um Co com Neoplasia de Ovrio
Autor:
Martins,A.R.C
1
*; Voorwald, F
2
; Ambrsio, A.M
3
; Fantoni, D. T
3
.
1- PhD student of Anesthesiology at FM-USP
2- PhD student of Surgery at UNESP-Jaboticabal
3- Professor in the Department of Veterinary Anesthesiology at FMVZ-USP
JLAVECC ISSN 1688-6100 4(1) 2012, pp 53-57
Fecha: 2012-02-01
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Abstract
Abdominal compartment syndrome (ACS) is a pathological condition caused by an acute and sustained
increase of intra-abdominal pressure (IAP), which reaches values above 20 mmHg associated with
organ dysfunction, acting negatively on respiratory, cardiovascular, spleen, neurological and renal
systems. Cardiovascular and respiratory depression is frequently observed being associated with chest's
compression, reduced cardiac output by cardiac tamponade and reduction of venous return by
compression of the abdominal caudal vena cava, respectively.
This report refers to a case of a female dog with ACS secondary to ovarian neoplasia and clearly
demonstras that increased IAP causes major hemodynamic disorders as evidenced by the significant
decrease in this parameter after decompression of the abdomen which made feasible the use of DPP as
a guide to volume administration. It also suggests the importance of such monitoring, especially of the
PIA, which is vital to understand the marked hemodynamic disorder at presentation and its correction
after surgical decompression. ACS is a predictor of mortality and should be treated immediately when
diagnosed.
Keywords: Abdominal compartment syndrome, Intra-abdominal pressure, Dogs.

Case report
A 12 years old mongrel female dog, weighting 16 Kg was presented with the history of ovarian cancer
and sent to therapeutic ovaryhisterectomy at the FMVZ Hovet/USP. The first clinical signs included
modified Glasgow scale (16 points), tachypnea (80 mpm), tachycardia (160 bpm) and hypotension (SBP
70 mmHg) refractory to fluid bolus with acellular hydroxyethyl starch 130/04 (15mL/Kg/15min). The
preoperative examinations showed hypoalbuminemia (0.9 g/dL) and hyperlactataemia (6mmol/L), severe
hypoxia (PaO2/FiO2 220mmHg), hypercapnia (PaCO2 95 mmHg) and acidemia (pH 7.0).
The anesthesia was induced with a combination of fentanyl (5 g/Kg) and midazolam (0.5 mg/Kg/IV),
folowed by maintenance with isoflurane under controlled volume ventilation (8mL/Kg) in a frequence to
allow permissible hypercapnia (PaCO2 45 to 60 mmHg). Analgesia was achieved with fentanyl (0.4
mg/Kg/min).
The presence of abdominal compartment syndrome was suspected which led to the measurement of
IAP, using a transducer connected to the bladder catheter and instilling 2mL/Kg saline through it.
Immediately after anesthesia's induction the following parameters were measured: central venous
pressure (CVP 12cmH
2
O), invasive blood pressure (MAP 45 mmHg), intra-abdominal pressure (IAP 22
mmHg), heart rate (HR 130bpm), pulse pressure variation(DPP 4%), arterial blood gases (mild
hypercapnia and acidemia) and central venous oxygen saturation (SVC 55%) demonstrating the
hemodynamic severity of the disorder.
Surgical decompression of the abdomen was performed with excision of the tumor and noradrenaline
infusion of 0.3 mg/kg/min preceded to the new measurement of the IAP (6 mmHg), PVC (6 cmH2O),
lactate (7.5 mmol/L) and DPP (22%) and MAP 50 mmHg. Since DPP represents 22% of volume
responsiveness, began volume resuscitation with hydroxyethyl starch 130/04 aiming to achieve DPP
value of 10%.
After three hours of post-operative period the patient's clinical signs had improved, including reduction of
lactate and 50% increase in SVC (75%). This report clearly demonstrated that increased IAP causes
major hemodynamic disorders as evidenced by the significant normalization of hemodynamic
parameters after abdominal decompression which made feasible the use of DPP as a guide to volume
administration. It also suggests the importance of such monitoring, especially of the PIA, which is vital to
14/03/12 20:05 Journal Laveccs
Pgina 2 de 2 http://www.journal.laveccs.org/full.php?id=323
administration. It also suggests the importance of such monitoring, especially of the PIA, which is vital to
understand the marked hemodynamic disorder and its correction after surgical decompression and
stabilization that were not only refered to the presence of the neoplasia by itself but from the secondary
effect over abdominal pressure. ACS is a predictor of mortality and should be treated immediately when
diagnosed.
Reporte do caso
Palavras chaves: Sndrome compartimental Abdominal, Presso intra abdominal, Ces
A sndrome compartimental abdominal (SCA) uma condio patolgica causada por aumento agudo e
sustentado da Presso Intra Abdominal (PIA) que atinge valores acima de 20 mmHg, associado a
disfuno orgnica, agindo negativamente nos sistemas respiratrio, cardiovascular, esplnico,
neurolgico e renal. A depresso respiratria e cardiovascular a mais observada sendo associada
compresso da caixa torcica, reduo do dbito cardaco por tamponamento cardaco e reduo do
retorno venoso por compresso da veia cava caudal abdominal, respectivamente.
Uma fmea canina, SRD, 12 anos, 16kg, acometida por neoplasia ovariana, foi encaminhada para
ovariohisterectomia teraputica no HOVET da FMVZ/USP, apresentando escala de Glasgow
modificada (16 pontos), taquipnia (80mpm), taquicardia (160bpm) e hipotenso (PAS 70mmHg)
refratria a bolus de fluido acelular Hidroxietilamido 130/04 (15mL/Kg/15min). Os exames pr-
operatrios demonstraram hipoalbuminemia (0,9g/dL) e hiperlactemia (6mmol/L), severa hipxia
(relao PaO2/FiO2 220mmHg), hipercapnia (PaCO2 95mmHg) e acidemia (pH 7.0).
A anestesia foi induzida por meio da associao de fentanil (5!g/Kg) e midazolan (0,5mg/Kg/IV), sendo
a manuteno realizada com isofluorano sob ventilao com volume controlado (8ml/kg), em
frequncia para manter hipercapnia permissvel (Paco2 45 a 60mmHg). A analgesia foi mantida por
fentanil (0,4!g/Kg/min). Suspeitou-se de presena de sndrome compartimental o que motivou a
mensurao da PIA, realizada por transdutor de presso conectado sonda vesical, administrando-se
para tanto 2mL/Kg de soluo salina. Imediatamente aps a induo da anestesia mensurou-se os
seguintes parmetros: presso venosa central (PVC 12cmH2O), presso arterial invasiva (PAM
45mmHg), presso intra abdominal (PIA 22mmHg), frequncia cardaca (Fc 130bpm), variao de
presso de pulso (DPP 4%), gasometria arterial (leve hipercapnia e acidemia). e a saturao venosa
central (SVC 55%) , demonstrando a gravidade do distrbio hemodinmico.
Foi realizada descompresso cirrgica do abdmen com exrese do tumor e iniciada infuso de
noradrenalina (0,3!g/Kg/min); procedeu-se a nova mensurao dos da PIA (6mmHg), PVC (6cmH
2
O),
lactato (7,5mmol/L) e DPP (22%), e PAM de 50mmHg. Visto que o DPP de 22% representa
responsividade a volume, iniciou-se ressuscitao volmica com hidroxietilamido 130/04 objetivando-se
atingir valor de DPP de 10%.
Em trs horas de ps-operatrio o animal apresentou melhora, incluindo reduo de 50% do lactato e
aumento da SVC (75%). Nesse relato demonstrou-se claramente que a PIA aumentada ocasionou
importante distrbio hemodinmico fato evidenciado pela significativa diminuio desse parmetro aps
a descompresso do abdmen o que tornou factvel o emprego do DPP como guia de administrao de
volume.
Conclui assim a importncia dessas monitorizao, principalmente da PIA, vital para compreenso
nesse caso que apresentou acentuado distrbio hemodinmico e cuja correo compreendia a
descompresso cirrgica e no apenas a estabilizao dos parmetros anormais consequentes
neoplasia. A SCA um fator preditivo de mortalidade e deve ser tratada imediatamente quando
diagnosticada.

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