Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942004000400005
Brazilian Journal of Anesthesiology
Scientific Article

Isquemia miocárdica silenciosa em pacientes submetidos à prostatectomia transuretral: comparação entre anestesia subaracnóidea e peridural

Silent myocardial ischaemia in patients undergoing transurethral resection of prostate: comparison of spinal versus epidural anaesthesia

Parshotam Lal Gautam; Sunil Katyal; Gurpreet Singh Wander; Harpreet Kaur

http://dx.doi.org/10.1590/S0034-70942004000400005 Braz J Anesthesiol, vol.54, n4, p.491-500, 2004
PDF Português
PDF English
Downloads: 0
Views: 1029

Resumo

JUSTIFICATIVA E OBJETIVOS: A isquemia miocárdica silenciosa foi recentemente relacionada ao aumento de morbimortalidade cardíaca peri-operatória. Até 41% dos pacientes com doença coronariana conhecida ou fatores de risco cardíaco, submetidos à cirurgias não cardíacas, apresentaram isquemia peri-operatória. Vários autores compararam técnicas de anestesia regional e geral mas nenhum comparou o impacto de diferentes técnicas de anestesia no neuro-eixo na incidência e duração da isquemia miocárdica silenciosa. O objetivo deste estudo foi comparar duas técnicas diferentes de anestesia no neuro-eixo (subaracnóidea versus peridural) em pacientes idosos aleatoriamente selecionados e submetidos à prostatectomia transuretral. Optou-se por este grupo de pacientes idosos porque freqüentemente, apresentam doença coronariana silenciosa ou clinicamente aparente. Um outro fator importante que influenciou a escolha, foi a sobrecarga de volume e tremores causados pela prostatectomia transuretral nesses pacientes promovendo desequilíbrio entre consumo e oferta de oxigênio. MÉTODO: Participaram deste estudo 40 pacientes submetidos a prostatectomia transuretral, que foram estudados em relação à isquemia miocárdica silenciosa com a ajuda de um equipamento Holter. A monitorização iniciou-se 1 hora antes da cirurgia, prosseguiu durante a cirurgia e após pelas próximas 24 horas. Os dados do Holter foram analisados por um DSM modelo 300. RESULTADOS: A incidência geral de isquemia miocárdica silenciosa neste estudo foi de 30%. Não foi estabelecida nenhuma relação entre isquemia miocárdica silenciosa e o tipo de anestesia. A maior parte dos episódios de isquemia miocárdica ocorreu no período pré-operatório e não tiveram relação com alterações hemodinâmicas. No entanto, a incidência e a gravidade de isquemia miocárdica silenciosa foi mais alta em pacientes com altos escores de Detsky, hipertensão arterial e anemia. Nenhum paciente apresentou efeitos cardíacos adversos. CONCLUSÕES: O tipo de anestesia no neuro-eixo não influenciou a incidência de isquemia miocárdica silenciosa.

Palavras-chave

CIRURGIA, DOENÇAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: In the recent past, silent myocardial ischaemia has been found to be associated with increased perioperative cardiac morbidity and mortality. As many as 41 % of patients with either known coronary artery disease or with cardiac risk factors, undergoing a non-cardiac surgery, develop perioperative ischaemia. Various authors have compared regional techniques with general Anaesthesia in selected groups but no one has compared the impact of different techniques of centroneuraxial block on incidence and duration of silent myocardial ischaemia. Thus we compared two different techniques of centroneuraxial block (Spinal versus Epidural block) in aged patients selected randomly undergoing TURP surgery. We took TURP patients as they belong to geriatric age group and often have silent or apparent coexistent coronary artery disease. Secondly, TURP surgery related volume overload and shivering in these patients lead to further oxygen demand supply mismatch. METHODS: Forty patients undergoing transurethral resection of prostate were monitored for perioperative silent myocardial ischaemia with the aid of a Holder device. Holter monitoring was started 1 hour prior to surgery and then continued during and after surgery the for next 24 hours. Holter data was analyzed using DSM model 300. RESULTS: The overall incidence of silent myocardial ischaemia in our study was 30%. No relationship could be established between silent myocardial ischaemia and type of centroneuraxial block. Most of the episodes of myocardial ischaemia occurred in preoperative period and, these had no correlation with hemodynamic fluctuations. However the incidence and load of silent myocardial ischaemia was higher in-patients with high Detsky scoring, hypertension and anaemia. None of the patient had any adverse cardiac outcome. CONCLUSIONS: Type of centroneuraxial block has no effect on incidence of silent myocardial ischaemia.

Keywords

ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, DISEASES, SURGERY

References

Mangano DT, Browner WS, Hollenberg M et al. Perioperative ischaemia research group. association of perioperative myocardial ischaemia with cardiac morbidity and mortality in men undergoing non cardiac surgery. N Eng J Med. 1990;323:1781-1788.

McCann RL, Clements FM. Silent myocardial ischaemia in patients undergoing peripheral vascular surgery: incidence and association with perioperative cardiac morbidity and mortality. J Vasc Surg. 1989;9:583-587.

Mangano DT, Hollenberg M, Fegert G et al. Perioperative myocardial ischaemia in patients undergoing noncardiac surgery: I. Incidence and severity during the 4 day perioperative period. The study of perioperative ischaemia (SPI) research group. J AM Coll Cardiol. 1991;17:843-850.

Mangano DT, Wong MG, London MJ et al. Perioperative myocardial ischaemia in patients undergoing noncardiac surgery: II. Incidence and severity during the 1st week after surgery. The study of perioperative ischaemia (SPI) research group J AM Coll Cardiol. 1991;17:851-857.

Lawson RA, Turner WH, Reeder MK at al. Haemodynamic effects of transurethral prostatectomy. Br J Urol. 1993;72:74-79.

Windsor A, French GW, Sear JW. Silent myocardial ischaemia in patients undergoing transurethral prostatectomy: A study to evaluate risk scoring and anaesthetic technique with outcome. Anaesthesia. 1996;51:728-732.

Blackburn H, Keys A, Simonson E. The electrocardiogram in population studies: A classification study. Circulation. 1960;21:1160-1175.

Landesberg G, Luria MH, Cotev S. Importance of long-duration postoperative ST- segment depression in cardiac morbidity after vascular surgery. The Lancet. 1993;341:715-719.

Edwards ND, Alford AM, Dobson PM. Myocardial ischaemia during tracheal intubation and extubation. Br J Anaesth. 1994;73:537-539.

Leung JM, Voskanian A, Bellows WH. Automated electrocardiograph ST segment trending monitors: accuracy in detecting myocardial ischaemia. Anesth Analg. 1998;87:4-10.

Metzler H, Gries M, Rehak P. Perioperative myocardial cell injury: the role of troponins. Br J Anaesth. 1997;78:386-390.

Noble JS, Reid AM, Jordan LV. Troponin I and myocardial injury in the ICU. Br J Anaesth. 1999;82:41-46.

Neill F, Sear JW, French G. Increases in serum concentrations of cardiac proteins and the prediction of early postoperative cardiovascular complications in noncardiac surgery patients. Anaesthesia. 2000;55:641-647.

Kaplan JA, Wells PH. Early diagnosis of myocardial ischaemia using the pulmonary arterial catheter. Anesth Analg. 1981;60:789-793.

Ellis JE, Shah MN, Briller JE. A comparison of methods for the detection of myocardial ischaemia during noncardiac surgery: automated ST-segment analysis systems, electrocardiography and transesophageal echocardiography. Anesth Analg. 1992;75:764-772.

Howie MB, Dzwonczyk R, McSweeney TD. An evaluation of a new two-electrode myocardial electrical impedance monitor for detecting myocardial ischaemia. Anesth Analg. 2001;92:12-18.

5dd7dc6d0e8825135213f286 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