Disfunção diastólica: sua importância para o anestesiologista

Marcos Guilherme Cunha Cruvinel; Carlos Henrique Viana de Castro

doi:10.1590/S0034-70942003000200011

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Disfunção diastólica: sua importância para o anestesiologista

Diastolic dysfunction: its importance to anesthesiologists

Marcos Guilherme Cunha Cruvinel; Carlos Henrique Viana de Castro

http://dx.doi.org/10.1590/S0034-70942003000200011 Braz J Anesthesiol, vol.53, n2, p.237-247, 2003

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Resumo

JUSTIFICATIVA E OBJETIVOS: Até recentemente, a insuficiência cardíaca foi vista como conseqüência primária da perda da capacidade contráctil do coração. Nos últimos anos, após a constatação de que pacientes com sinais e sintomas clássicos de insuficiência cardíaca tinham função sistólica ventricular preservada, grande importância à função diastólica do ventrículo esquerdo vem sendo dada. O aumento da perspectiva de vida da população, a melhoria das técnicas cirúrgicas e anestésicas e a grande incidência dos seus fatores predisponentes fazem com que, cada vez mais, pacientes com disfunção ou insuficiência diastólica apresentem-se para procedimentos anestésicos. Este artigo tem como objetivo rever a definição, causas, prevalência, diagnóstico, tratamento da disfunção diastólica, além da abordagem anestésica dos pacientes que a apresentam. CONTEÚDO: Revisão sobre a função diastólica do ventrículo esquerdo e implicações da disfunção diastólica para o anestesiologista. CONCLUSÕES: Não há benefício comprovado de uma técnica anestésica sobre outra. Os principais objetivos anestésicos visam à manutenção da volemia e do ritmo sinusal, além de evitar taquicardia, hipertensão arterial e isquemia miocárdica. As drogas mais freqüentemente usadas com esses objetivos são os beta-bloqueadores.

Palavras-chave

ANESTESIA, DOENÇAS, DOENÇAS

Abstract

BACKGROUND AND OBJECTIVES: Until recently, heart failure was primarily viewed as an event affecting heart contractility. However recently, after the recognition that several patients with classic signs and symptoms of heart failure had normal systolic function, left ventricular diastolic function is receiving major attention. The increase in populations life expectancy, surgical and anesthetic techniques improvements of the high prevalence of risk factors are increasing the number of patients with diastolic failure or dysfunction being referred to surgery and anesthesia. This article aims at reviewing diastolic dysfunction definition, causes, prevalence, diagnosis, management and anesthetic implications. CONTENTS: Left ventricular diastolic function and its importance to anesthesiologists are described. CONCLUSIONS: There are no proven benefits of an anesthetic technique over the others. Primary anesthetic goals are to maintain normal volume status and sinusoidal rhythm, in addition to preventing tachycardia, arterial hypertension and ventricular ischemia. Beta-blockers are the drugs more frequently used to meet these goals.

Keywords

ANESTHESIA, DISEASES, DISEASES

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Disfunção diastólica: sua importância para o anestesiologista

Diastolic dysfunction: its importance to anesthesiologists

Marcos Guilherme Cunha Cruvinel; Carlos Henrique Viana de Castro

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Diastolic dysfunction: its importance to anesthesiologists