Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942003000400001
Brazilian Journal of Anesthesiology
Scientific Article

Avaliação hemodinâmica e metabólica da infusão contínua de dexmedetomidina e de remifentanil em colecistectomia videolaparoscópica: estudo comparativo

Hemodynamic and metabolic evaluation of dexmedetomidine and remifentanil continuous infusion in videolaparoscopic cholecystectomy: comparative study

Thatiany Pereira Chaves; Josenília Maria Alves Gomes; Francisco Elano Carvalho Pereira; Sara Lúcia Cavalcante; Ilse M. Tigre de Arruda Leitão; Hipólito Sousa Monte; Rodrigo Dornfeld Escalante

http://dx.doi.org/10.1590/S0034-70942003000400001 Braz J Anesthesiol, vol.53, n4, p.419-430, 2003
PDF
Downloads: 0
Views: 709

Resumo

JUSTIFICATIVA E OBJETIVOS: A dexmedetomidina tem sido utilizada para sedação e como coadjuvante em anestesia geral. O objetivo deste estudo foi avaliar a resposta cardiovascular e simpático-adrenal à intubação traqueal e à insuflação do pneumoperitônio, comparando-a ao remifentanil durante anestesia com sevoflurano para colecistectomia videolaparoscópica. MÉTODO: Foram incluídos no estudo 42 pacientes, estado físico ASA I ou II, com idades entre 25 e 55 anos, distribuídos aleatoriamente em dois grupos: GI e GII. A indução da anestesia foi realizada com infusão contínua de 1 µg.kg-1 de dexmedetomidina (GI) ou remifentanil (GII), durante 10 minutos, seguido de propofol e cisatracúrio. A manutenção da anestesia foi realizada com a infusão contínua de 0,7 µg.kg-1.h-1 de dexmedetomidina ou 0,5 µg.kg-1.h-1 de remifentanil e concentrações variadas de sevoflurano. Foram anotadas a PAS, PAD e FC nos momentos: M1 - antes do início da infusão inicial da droga; M2 - após término da infusão inicial da droga; M3 - após a intubação orotraqueal; M4 - antes do início do pneumoperitônio; M5 - após o pneumoperitônio; M6 - cinco minutos após desinsuflado o pneumoperitônio, M7 - após extubação traqueal. Em M4, M5 e M6 foram dosadas adrenalina e noradrenalina. A concentração expirada (CE) do sevoflurano, a relação CE/CAM, consumo de sevoflurano foram registrados em M4, M5 e M6. RESULTADOS: Variações na PAS e PAD foram maiores no grupo da dexmedetomidina em M4 a M5. A FC e os níveis de adrenalina e noradrenalina não apresentaram diferença entre os grupos. A CE do sevoflurano foi maior em M4 e M6 no GI, assim como a CE/CAM. No GI, o consumo de sevoflurano foi maior e observou-se uma tendência para menor consumo de analgésicos e antieméticos. CONCLUSÕES: Nas condições deste estudo, a dexmedetomidina inibiu a liberação de catecolaminas durante a intubação orotraqueal e o pneumoperitônio, porém, não impediu o aumento da pressão arterial em resposta à insuflação peritoneal.

Palavras-chave

ANALGÉSICOS, ANALGÉSICOS, CIRURGIA, CIRURGIA, HIPNÓTICOS

Abstract

BACKGROUND AND OBJECTIVES: Dexmedetomidine has been used for sedation and as coadjuvant drug in general anesthesia. This study aimed at evaluating cardiovascular and sympathetic-adrenal responses to tracheal intubation and pneumoperitoneum inflation with dexmedetomidine, as compared to remifentanil during anesthesia with sevoflurane for videolaparoscopic cholecystectomy. METHODS: Forty two physical status ASA I or II patients, aged 25 to 55 years, were randomly distributed in two groups: GI and GII. Anesthesia was induced with 1 µg.kg-1 dexmedetomidine (GI) or remifentanil (GII) continuous infusion for 10 minutes, followed by propofol and cisatracurium. Anesthesia was maintained with 0.7 µg.kg-1.h-1 dexmedetomidine or 0.5 µg.kg-1.h-1 remifentanil continuous infusion and different sevoflurane concentrations. SBP, DBP and HR were recorded in the following moments: M1 - before initial drug infusion; M2 - after end of initial drug infusion; M3 - after tracheal intubation; M4 - before pneumoperitoneum; M5 - after pneumoperitoneum; M6 - five minutes after pneumoperitoneum deflation; M7 - after tracheal extubation. Epinephrine and norepinephrine were dosed in M4, M5 and M6. Sevoflurane expired concentration (EC), EC/MAC ratio and sevoflurane consumption were recorded in M4, M5 and M6. RESULTS: SBP and DBP variations were higher in the dexmedetomidine group in M4 and M5. HR, epinephrine and norepinephrine levels were similar between groups. Sevoflurane EC was higher in M4 and M6 for GI, as well as EC/MAC ratio. There has been a higher sevoflurane consumption in GI, with a trend to less analgesics and anti-emetics consumption. CONCLUSIONS: In the conditions of our study, dexmedetomidine has inhibited catecholamine release during tracheal intubation and pneumoperitoneum, however, has not prevented blood pressure increase in response to peritoneal inflation.

Keywords

ANALGESICS, ANALGESICS, HIPNOTICS, SURGERY, SURGERY

References

Anand KJS, Philbin D, Hickey PR. Halothane-morphine compared with high dose sufentanil for anesthesia and postoperative analgesia in neonate cardiac surgery. N Engl J Med. 1992;326:1-4.

Mora CT, Dudek C, Torjman MC. The effects of anaesthetic technique on the hemodynamic response and recovery profile in coronary revascularization patients. Anesth Analg. 1995;81:900-905.

Kono K, Philbin DM, Coggins CH. Renal Function and stress response during halothane or fentanyl anesthesia. Anesth Analg. 1981;60:552-556.

Okum GS, Colonna-Romano P, Horrow JC. Vomiting after alfentanil anesthesia: Effect of dosing method. Anesth Analg. 1992;75:558-562.

Sukhani R, Vazquez J, Pappas AL. Recovery after propofol with and without intraoperative fentanyl in patient undergoing ambulatory gynecologic laparoscopy. Anesth Analg. 1996;83:975-980.

Brockmann C, Raasch W, Bastian C. Endocrine stress parameters during TIVA with remifentanil, fentanyl, or sufentanil. Anaesth Intens Noft Schmerzther. 2000;35:685-691.

Flacke JW, Bloor BC, Flacke WE. Reduced narcotic requirement fentanyl by clonidine with improved hemodynamic and adrenergic stability in patients undergoing coronary bypass surgery. Anesthesiology. 1987;67:11-19.

Ghignone M, Calvillo O, Quintin L. Anesthesia and hypertension: the effect of clonidine an perioperative hemodynamics and isoflurane requirements. Anesthesiology. 1987;67:3-10.

Ghignone M, Quintin L, Duke D. Effects of clonidine on narcotics requirement fentanyl and hemodynamics response during induction of anesthesia and endotraqueal intubation. Anesthesiology. 1986;64:36-42.

Orko R, Pouttu J, Ghignone M. Effect of clonidine on hemodynamics response to endotraqueal intubation on gastric acidity. Acta Anaesthesiol Scand. 1987;31:325-329.

Maze M, Birch B, Vickery R. Clonidine reduces halothane MAC in rats. Anesthesiology. 1987;67:868-869.

Kaukinen S, Pyykko K. The potentiation of halothane anesthesia by clonidine. Acta Anaesthesiol Scand. 1979;23:107-111.

Maze M, Tranquilli W. Alpha 2 adrenoceptor agonists: defining the role in clinical anesthesia. Anesthesiology. 1991;74:581-605.

Aantaa R, Scheinin M. Alpha-2 adrenergic agents in anaesthesia. Acta Anaesthesiol Scand. 1993;37:433-448.

Venn RM, Bryant A, Hall GM. Effects of dexmedetomidine on adrenocortical function and the cardiovascular, endocrine and inflammatory response in postoperative patients needing sedation in the intensive care unit. Br J Anaesth. 2000;86:650-656.

Aantaa R, Jaakola M-L, Kallio A. Reduction of the minimum alveolar concentration of isoflurane by dexmedetomidine. Anesthesiology. 1997;86:1055-160.

Fragen RJ, Fitzgerald PC. Effect of dexmedetomidine on the minimum alveolar concentration (MAC) of sevoflurane in adults age 55 to 70 years. J Clin Anesth. 1999;11:466-470.

Scheinin B, Lindgren L, Randell T. Dexmedetomidine attenuates sympathoadrenal response to traqueal intubation and reduce the need for thiopentone and peroperative fentanyl. Br J Anaesth. 1992;68:126-131.

Aho M, Scheinin M, Lehtinen A-M. Intramusculary administered dexmedetomidine attenuates hemodynamic and stress hormone response to gynecologic laparoscopy. Anesth Analg. 1992;75:932-939.

Dutta S, Karol MD, Cohen T. Effect of dexmedetomidine on propofol requirements in healthy subjects. J Pharm Scienc. 2001;90:172-181.

Degani ALG, Cass QB, Vieira PC. Cromatografia um breve ensaio. Química nova escola. 1998;7:21-25.

Nunes RR, Cavalcante SL. Influência da dexmedetomidina na concentração expirada do sevoflurano: Avaliação pelo índice bispectral, taxa de supressão e análise espectral da potência do eletroencefalograma. Rev Bras Anestesiol. 2002;52:133-145.

Lentschener C, Axler O, Fernandez H. Haemodynamic changes and vasopressin release are not consistently associated with carbon dioxide pneumoperitoneum in humans. Acta Anaesthesiol Scand. 2001;45:527-535.

Joris JL, Chiche JD, Canivet JL. Hemodynamic changes induced by laparoscopy and their endocrine correlates: effects of clonidine. J Am Coll Cardiol. 1998;32:1389-1396.

O’Leary E, Hubbard K, Tormay W. Laparoscopic cholecystectomy: haemodynamic and neuroendocrine responses after pneumoperitoneum and changes in position. Br J Anaesth. 1996;77:640-644.

Joris JL, Chiche JD, Canivet JL. Hemodynamics changes induced by laparoscopy and their endocrine correlates: effects of clonidine. J Am Coll Cardiol. 1998;35:1389-1396.

Mikami O, Fujise K, Matsumoto S. High intra-abdominal pressure increases plasma cathecolamine concentration during pneumoperitoneum for laparoscopic procedures. Arch Surg. 1998;133:39-43.

Myre K, Rostrup M, Buanes T. Plasma cathecolamines and haemodynamics changes during pneumoperitoneum. Acta Anaesthesiol Scand. 1998;42:343-347.

Delitalia G, Trainer PJ, Oliva O. Opioid peptide and alpha-adrenoceptor pathways in the regulation of the pituitary adrenal axis in man. J Endocrinol. 1994;141:163-169.

Stanley TH, Berman L, Green O. Plasma cathecolamine and cortisol responses to fentanyl-oxygen anesthesia for coronary-artery operations. Anesthesiology. 1980;53:250-255.

Sebel PS, Bovil JG, Schellekens APM. Hormonal responses of high-dose fentanyl anesthesia: a study in patients undergoing cardiac surgery. Br J Anaesth. 1981;53:941-945.

5ddd30dd0e882511731da3e9 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections