Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000100002
Brazilian Journal of Anesthesiology
Scientific Article

Dose preparatória versus injeção única: estudo comparativo entre diferentes doses de cisatracúrio

Priming versus bolus: a comparative study with different cisatracurium doses

Angélica de Fátima de Assunção Braga; Glória Maria Braga Potério; Franklin Sarmento da Silva Braga; Eugesse Cremonesi; Francisco Pena Siqueira; Vanessa H Carvalho

http://dx.doi.org/10.1590/S0034-70942003000100002 Braz J Anesthesiol, vol.53, n1, p.9-16, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: A técnica da dose preparatória é uma alternativa para encurtar o tempo de latência dos bloqueadores neuromusculares adespolarizantes. O objetivo deste estudo foi avaliar o tempo para instalação do bloqueio neuromuscular máximo, as condições de intubação traqueal e as alterações cardiocirculatórias ocasionadas por diferentes doses de cisatracúrio em injeção única e em doses fracionadas. MÉTODO: Foram estudados 80 pacientes, estado físico ASA I e II, distribuídos em dois grupos de acordo com a dose de cisatracúrio: Grupo I (0,1 mg.kg-1) e Grupo II (0,2 mg.kg-1). Formaram-se subgrupos de acordo com a técnica de curarização usada: Subgrupos P1 e P2 (dose preparatória) - 0,02 mg.kg-1ou 0,04 mg.kg-1 de cisatracúrio, respectivamente, seguido após um minuto de 0,08 mg.kg-1 ou 0,16 mg.kg-1 do mesmo bloqueador neuromuscular, respectivamente; Subgrupos U1 e U2 - injeção única de dose total de 0,1 mg.kg-1 ou 0,2 mg.kg-1 de cisatracúrio, respectivamente. A Indução anestésica foi feita com etomidato precedido de alfentanil. A função neuromuscular foi monitorizada empregando-se a SQE a cada 12 segundos. Foram avaliados: o tempo para instalação do bloqueio neuromuscular máximo; as alterações de pressão arterial média e de freqüência cardíaca, e as condições de intubação traqueal. RESULTADOS: Os tempos para instalação do bloqueio neuromuscular máximo foram: Grupo I (3,90 ± 0,60 min e 3,88 ± 0,74 min, nos subgrupos P1 e U1, respectivamente) e Grupo II (1,40 ± 0,40 min e 2 ± 0,30 min, nos subgrupos P2 e U2, respectivamente) sem diferença significativa. A comparação entre os subgrupos P1 e P2 e os subgrupos U1 e U2, mostrou diferença significativa. As condições de intubação traqueal foram aceitáveis em todos os pacientes sem alterações cardiocirculatórias. CONCLUSÕES: As doses empregadas de cisatracúrio não encurtou o tempo para a instalação do bloqueio neuromuscular máximo, em relação ao seu emprego em injeção única, porém proporcionaram condições aceitáveis de intubação traqueal, sem alterações cardiocirculatórias.

Palavras-chave

BLOQUEADORES NEUROMUSCULARES, BLOQUEADORES NEUROMUSCULARES

Abstract

BACKGROUND AND OBJECTIVES: The priming technique is an alternative to shorten nondepolarizing neuromuscular blockers onset time. This study aimed at evaluating maximum neuromuscular block onset, tracheal intubation conditions and cardiocirculatory changes determined by different cisatracurium single or fractional doses. METHODS: Participated in this study 80 patients physical status ASA I and II, who were distributed into two groups according to cisatracurium doses: Group I (0.1 mg.kg-1) and Group II (0.2 mg.kg-1). Subgroups were constituted according to the curarization technique employed: subgroups P1 and P2 (priming-dose) - 0.02 mg.kg-1 or 0.04 mg.kg-1cisatracurium, respectively, followed one minute later, by 0.08 mg.kg-1 or 0.16 mg.kg-1 of the same neuromuscular blocker, respectively; subgroups U1 and U2 - total bolus injection of 0.1 mg.kg-1 or 0.2 mg.kg-1 cisatracurium, respectively. Anesthesia was induced with etomidate, preceded by alfentanil. Train of Four (TOF) stimulation was applied at 12-second intervals to monitor neuromuscular function. Maximum neuromuscular blockade onset time, tracheal intubation conditions and changes in hemodynamic parameters (arterial mean blood pressure and heart rate) were evaluated. RESULTS: Mean times for maximum neuromuscular block onset were: Group I (3.90 ± 0.60 min and 3.88 ± 0.74 min, for subgroups P1 and U1, respectively) and Group II (1.40 ± 0.40 min and 2 ± 0.30 min, for subgroups P2 and U2, respectively) with no significant differences. Comparison between subgroups P1 and P2 and between subgroups U1 and U2, has shown statistically significant differences. Tracheal intubation conditions were acceptable in all patients and there were no cardiovascular changes. CONCLUSIONS: Fractional cisatracurium doses have not shortened maximum neuromuscular block onset as compared to bolus injections. They have however produced acceptable tracheal intubation conditions without cardiovascular changes.

Keywords

NEUROMUSCULAR BLOCKERS, NEUROMUSCULAR BLOCKERS

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