Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000200007
Brazilian Journal of Anesthesiology
Scientific Article

Dexmedetomidina associada a propofol em sedação durante anestesia local para cirurgia plástica

Dexmedetomidine/propofol association for plastic surgery sedation during local anesthesia

José Roberto Nociti; Paulo Sérgio Mateus Serzedo; Eduardo Barbin Zuccolotto; Fabiana Sebben; Raul F. Gonzales

http://dx.doi.org/10.1590/S0034-70942003000200007 Braz J Anesthesiol, vol.53, n2, p.198-208, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: A dexmedetomidina é um novo agonista alfa2-adrenérgico com propriedades potencialmente úteis em anestesia. Este estudo comparativo tem por finalidade observar os efeitos da dexmedetomidina sobre o consumo de propofol e a evolução dos parâmetros cardiovasculares e respiratórios, quando incluída em técnica de sedação durante anestesia local em cirurgia plástica. MÉTODO: Participaram do estudo 40 pacientes do sexo feminino com idades entre 16 e 60 anos, estado físico ASA I ou II, submetidas a cirurgias plásticas eletivas sob anestesia local. Foram distribuídas aleatoriamente em dois grupos de vinte: C (controle) e D (dexmedetomidina). Em ambos, a sedação foi obtida com propofol na dose em bolus inicial de 1 mg.kg-1 seguida de infusão contínua em velocidade ajustada para se obter grau de sedação consciente. No grupo D, as pacientes receberam infusão venosa contínua de dexmedetomidina à velocidade de 0,01 µg.kg-1.min-1, concomitante com a de propofol. Foram avaliados: efeito da dexmedetomidina sobre o consumo de propofol; variação dos parâmetros cardiovasculares (PAS, PAD, PAM, FC) e respiratórios (SpO2, P ET CO2); qualidade do controle do sangramento per-operatório e características da recuperação pós-anestésica. RESULTADOS: A velocidade média de infusão de propofol foi menor no grupo D (35,2 ± 5,3 µg.kg-1.min-1) do que no grupo C (72,6 ± 8,5 µg.kg-1.min-1). Os valores médios de PAS, PAD e PAM decresceram em relação ao inicial, a partir dos 30 minutos, no grupo D, mantendo-se a seguir estáveis até o final; no grupo C, aumentaram. A FC manteve-se estável no grupo D e aumentou a partir dos 30 minutos no grupo C. O tempo médio para obedecer ao comando de "abrir os olhos" foi menor no grupo D (6,3 ± 2,5 min) em relação ao C (8,9 ± 2,7 min). O controle do sangramento per-operatório foi superior no grupo D em relação ao C. CONCLUSÕES: O emprego da dexmedetomidina associada ao propofol apresenta as seguintes vantagens: redução do consumo de propofol, estabilidade dos parâmetros cardiovasculares, controle adequado do sangramento per-operatório, ausência de efeito importante sobre a ventilação.

Palavras-chave

ANESTESIA, ANESTESIA, CIRURGIA, HIPNÓTICOS, HIPNÓTICOS

Abstract

BACKGROUND AND OBJECTIVES: Dexmedetomidine is a new alpha2-adrenergic receptor agonist with potentially useful characteristics for anesthesia. This comparative study aimed at evaluating the effects of dexmedetomidine on propofol requirements and cardiovascular/respiratory stability during plastic surgery sedation under local anesthesia. METHODS: Participated in this study 40 female patients aged 16 to 60 years, physical status ASA I or II, scheduled for elective face, nose and breast plastic surgeries under local anesthesia. Patients were randomly allocated into two groups of twenty patients: C (control) and D (dexmedetomidine). Sedation was achieved in both groups with 1 mg.kg-1 bolus propofol followed by continuous infusion at an adjusted rate to provide conscious sedation. Group D patients received continuous intravenous dexmedetomidine at a rate of 0.01 µg.kg-1.min-1, concomitant with propofol infusion. The following were evaluated: effect of dexmedetomidine on propofol requirements; cardiovascular (SBP, DBP, MBP, HR) and respiratory (SpO2, P ET CO2) parameters; quality of perioperative bleeding control and postanesthetic recovery features. RESULTS: Mean propofol infusion rate was lower in group D (35.2 ± 5.3 µg.kg-1.min-1) as compared to group C (72.6 ± 8.5 µg.kg-1.min-1). Mean SBP, DBP, MBP values have decreased as from 30 min in group D, remaining stable until procedure completion, while in Group C they have increased. HR remained stable in group D where as increased as from 30 min in group C. Mean time to open eyes under command was lower in group D (6.3 ± 2.5 min) as compared to group C (8.9 ± 2.7 min). Perioperative bleeding control was better in group D as compared to group C. CONCLUSIONS: Dexmedetomidine/propofol association for sedation is safe and has the following advantages: decrease in propofol requirements, cardiovascular stability, good perioperative bleeding control, lack of significant effects on ventilation.

Keywords

ANESTHESIA, ANESTHESIA, HYPNOTICS, HYPNOTICS, SURGERY

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