Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000200002
Brazilian Journal of Anesthesiology
Scientific Article

Alterações eletroneurofisiológicas em anestesia com sevoflurano: estudo comparativo entre pacientes saudáveis e pacientes com paralisia cerebral

Electroneourophysiological changes in anesthesia with sevoflurane: comparative study between healthy and cerebral palsy patients

Sérgio Silva de Mello; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942003000200002 Braz J Anesthesiol, vol.53, n2, p.150-159, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: Estudos avaliando a farmacodinâmica de drogas anestésicas em Paralisia Cerebral (PC) são escassos. O objetivo deste estudo foi comparar a resposta eletroneurofisiológica de pacientes normais e com PC à anestesia com sevoflurano, utilizando o EEG bispectral (BIS) e potencial evocado somatossensitivo de curta latência (PESS) como técnica de monitorização do grau de profundidade anestésica. MÉTODO: Foram selecionados 24 pacientes de 3 a 18 anos, candidatos a cirurgias na Rede Sarah de Hospitais do Aparelho Locomotor, divididos em 2 grupos: 1. PC - 12 crianças com PC tipo espástica; 2. Controle (C) - 12 crianças sem doença do SNC. A anestesia foi realizada com sevoflurano associado a N2O a 60% em ventilação assistida. As variáveis BIS e ondas N9, N13, N19 e P/N 22 do PESS - latência e amplitude - foram avaliadas nas frações expiradas de sevoflurano (FEsev) de 1,2 e 2,5% (0,5 e 1 CAM). Foram monitorizadas a temperatura e a P ET CO2. Para análise foram utilizadas média e desvio-padrão para o BIS, e média da variação percentual dos valores de latência e amplitude das ondas do PESS, nas duas concentrações do anestésico. RESULTADOS: Não houve diferença de sexo, idade, peso e temperatura entre os grupos. Sob efeito da anestesia, os valores de BIS foram mais reduzidos no grupo PC, sendo a diferença entre os grupos estatisticamente significante com a FEsev 2,5% (30,3 x 37,5; p < 0,05). O aumento percentual da latência das ondas do PESS foi maior no grupo PC. CONCLUSÕES: Os resultados sugerem um efeito depressor maior do anestésico no grupo com PC, sendo esta diferença captada pelo BIS e PESS.

Palavras-chave

ANESTÉSICOS, ANESTÉSICOS, DOENÇA, DOENÇA, MONITORIZAÇÃO, MONITORIZAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: There are very few studies on anesthetic drugs pharmacodynamics in patients with Cerebral Palsy (CP). This study aimed at comparing electroneurophysiological responses in healthy and CP patients, using bispectral index (BIS) and short-latency somatosensory evoked potential (SEP) to monitore sevoflurane-induced central nervous system (CNS) electroneurophysiological changes. METHODS: Twenty four patients aged 3 to 18 years, scheduled for surgical procedures were allocated in two groups: 1. CP - 12 patients with spastic CP; 2. Control (C) - 12 patients with no neurological disease. Anesthesia was induced with sevoflurane and 60% N2O in assisted ventilation. BIS and N9, N13, N19 and N/P22 SEP waveforms - amplitude and latency - were recorded at baseline and at 1.2% and 2.5% end-tidal sevoflurane concentration (ETsev), corresponding to 0.5 and 1 MAC, respectively. Monitoring consisted of temperature, ETsev and P ET CO2. For statistical analysis, BIS mean and standard deviation as well as means percentage variation of SEP waveforms latency and amplitude in both anesthetic concentrations, were used. RESULTS: There were no significant differences in gender, age, weight and temperature between groups. Under anesthesia, BIS values were lower in the CP group, whit statistical significance only at 2.5% ETsev (30.3 x 37.5; p < 0.05). Percentage SEP waveforms latency increase was higher in the CP group. CONCLUSIONS: Results suggest a deeper anesthetic depressing effect in the CP group and this difference was captured by BIS and SEP waves.

Keywords

ANESTHETICS, ANESTHETICS, DISEASE, DISEASE, MONITORING, MONITORING

References

Bax COM. Terminology and classification of cerebral palsy. Dev Med Child Neurol. 1964;6:295-297.

Frei FJ, Haemmerle MH, Brunnner R. Minimum alveolar concentration for halothane in children with cerebral palsy and several mental retardation. Anaesthesia. 1997;52:1056-1060.

Katoh T, Suzuki A, Ikeda K. Electroencephalographic derivates as a tool for predicting the depth of sedation and anesthesia induced by sevoflurane. Anesthesiology. 1998;88:642-650.

Vaughan DJA, Thornton C, Wright JR. Effects of different concentrations of sevoflurane and desflurane on subcortical somatosensory evoked responses in anaesthetized, non-stimulated patients. Br J Anaesth. 2001;86:59-62.

Campos da Paz Jr A, Burnett SW, Nomura AM. Neuromuscular Affections in Children. Mercer’s Orthopedics Surgery. 1996:399-474.

Theroux MC, Brandom BW, Zagnoev M. Dose response of succinylcholine at the adductor pollicis of children with cerebral palsy during propofol and nitrous oxide anesthesia. Anesth Analg. 1994;79:761-765.

Dierdoff F, McNiece WL, Rao CC. Effect of succinylcholine on plasma potassium in children with cerebral palsy. Anesthesiology. 1985;62:88-90.

Nolan J, Chalkiadis GA, Low J. Anesthesia and pain management in cerebral palsy. Anaesthesia. 2000;55:32-41.

Viegas O, Stoelting RK. Halothane MAC in dogs unchanged by phentobarbital. Anesth Analg. 1976;55:677-679.

Bannister CF, Brosius KK, Sigl JC. The effect of bispectral index monitoring on anesthetic use and recovery in children anesthetized with sevoflurane in nitrous oxide. Anesth Analg. 2001;92:877-881.

Costa VV, Saraiva RA, Almeida AC. The effects of nitrous oxide on the inhibition of somatosensory evoked potential by sevoflurane in children. Anaesthesia. 2001;56:202-207.

Denman W, Swanson E, Rosow D. Pediatric evaluation of the bispectral index (BIS) monitor and correlation of BIS with end-tidal sevoflurane concentration in infants and children. Anesth Analg. 2000;90:872-877.

Woodforth IJ, Hicks RG, Crawford MR. Depression of I waves in corticospinal volleys by sevoflurane, thiopental, and propofol. Anesth Analg. 1999;89:1182-1189.

Angel A. Central neuronal pathways and the process of anaesthesia. Br J Anaesth. 1993;71:148-163.

Miller G. Cerebral Palsies an Overview. The Cerebral Palsies: Causes, Consequences and Management. 1998:1-35.

Volpe JJ. Subplate neurons: missing link in brain injury of premature infant?. Pediatrics. 1996;97:112-113.

Newman J. Thalamic contributions to attention and consciousness. Conscious Cogn. 1995;41:72-93.

Chamoun NG. The position of aspect. Anesthesiology. 2000;92:897-898.

Bruhn J, Bouillon T, Shafter SL. Electromyographic activity falsely elevates the bispectral index. Anesthesiology. 2000;92:1485-1491.

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