Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942002000100013
Brazilian Journal of Anesthesiology
Special Article

Mecanismo de ação dos anestésicos inalatórios

Action mechanism of inhalational anesthetics

Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942002000100013 Braz J Anesthesiol, vol.52, n1, p.114-123, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: Estudos clínicos e experimentais têm sido desenvolvidos para identificar os locais onde os anestésicos (inalatórios) atuam e para determinar quais as alterações funcionais que esses fármacos produzem nas estruturas do sistema nervoso central determinantes do estado de anestesia que é observado clinicamente. O objetivo deste trabalho é descrever os resultados obtidos por vários autores em estudos clínicos e experimentais realizados recentemente na tentativa de esclarecer os mecanismos de ação dos anestésicos inalatórios no sistema nervoso central. CONTEÚDO: Para facilitar a compreensão dos complexos mecanismos de ação dos anestésicos inalatórios no sistema nervoso central, eles foram divididos em três níveis: o macroscópico, o microscópico e o molecular. Recentemente um grupo de autores descreveram estes mecanismos de ação em: orgânicos, celulares, e inibidores da entropia. Estes mecanismos tentariam explicar o estado de anestesia que teria como característica a capacidade de prover ao paciente duas ações principais: 1) imobilidade, inibição da resposta a estímulos nociceptivos; e 2) amnésia. Outros efeitos (desejáveis) também são obtidos pela administração de anestésicos: analgesia e hipnose. Entretanto, tais efeitos seja isoladamente ou juntos, não definem o estado de anestesia. Embasados nestes conceitos, este grupo adota e divulga a classificação dos anestésicos em: 1) anestésicos completos, os que produzem imobilidade e amnésia; e 2) incompletos ou não imobilizantes, os que não produzem imobilidade mas produzem amnésia. CONCLUSÕES: De acordo com os resultados de vários estudos realizados recentemente, provavelmente a amnésia e a inconsciência ocorrem pela ação do anestésico predominantemente no cérebro, enquanto a imobilidade, ou seja, a inibição da resposta ao estímulo nociceptivo por movimento, seria pela ação do anestésico preferencialmente e inicialmente na medula espinhal. Estas ações ocorrem por inibição da transformação de energia (entropia) que forma os potenciais de ação nas células (fibras) nervosas, especialmente nas sinapses.

Palavras-chave

ANESTÉSICOS, Inalatórios

Abstract

BACKGROUND AND OBJECTIVES: Clinical and experimental studies have been developed to identify inhalational anesthetics action sites to determine clinically observed functional changes produced on central nervous system structures responsible for the anesthetic status. This study aimed at reviewing results obtained by several authors in recent clinical and experimental studies in an attempt to explain action mechanisms of inhalational anesthetics on the central nervous system. CONTENTS: To help understanding the complex action mechanisms of inhalational anesthetics on the central nervous system, these were divided in three levels: macroscopic, microscopic, and molecular. A group of authors have recently divided those action mechanisms in: organic, cellular, and entropy inhibitors. These mechanisms would try to explain the anesthetic status able to provide patients with two major reactions: 1) immobility in response to noxious stimuli and 2) amnesia. Other desirable effects, such as analgesia and hypnosis are also obtained by inhalational anesthesia, however such effects per se or in combination, do not define the anesthetic status. Based on those concepts, this group classifies inhalational anesthetics as: 1) complete anesthetics, or providing immobility and amnesia; and 2) incomplete anesthetics, or not providing immobility, but providing amnesia. CONCLUSIONS: According to several recent studies, it is possible that amnesia and unconsciousness are a consequence of the anesthetic action predominantly on the brain, while immobility, that is, inhibition of motor response to noxious stimuli, would be a consequence of the preferential and initial anesthetic action on the spinal cord. These actions occur by energy transformation inhibition (entropy) generating action potentials in nervous cells (fibers), particularly the synapses.

Keywords

ANESTHETICS, Inhalational

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