Uso de morfina peridural em pacientes com disautonomia após traumatismo craniencefálico

Use of peridural morphine in patients with posttraumatic autonomic disturbances Introduction: The dysautonomia sympathetic hyperactivity or sympathetic storm syndrome (SSS) can occur in one third of patients with severe brain trauma, however, is still an entity without established treatment. The use of intravenous morphine is described for the treatment of SSS, and noted improvement mainly to lower frequencies of breathing and heartbeat. In this study we examine the effects of epidural morphine in patients with SSS. Patients and methods: We evaluated 3 patients (2 male, 1 female), with an average age of 20.6 years, victims of severe head trauma that presented SSS in hospital stay. The data collected included details of trauma, of physiology, medications used and symptoms. In these patients, infusion of morphine was realized 4 to 6 mg/d in the epidural space in the dorsal level with an average of 25.6 days. Results: Two patients had tomographic signs of diffuse axonal injury and one patient had a large acute epidural hematoma underwent to surgery. The main symptoms found in three patients, were dysautonomia, sweating, tachycardia, hyperthermia and postures distonics. In two patients, the stiffness was comprehensive and in one patient in the distonic posture in left side. After the procedure of the epidural catheter implant with infusion of morphine was found in the &rst week an improvement of symptoms of hyperactivity sympathetic. Conclusion: The use of epidural morphine can be an alternative treatment for sympathetic hyperactivity in patients with SSS.