Manuseio peri-operatório do paciente em uso de amiodarona

Gilson Ramos; José Ramos Filho; Edisio Pereira; Salustiano Gabriel Neto; Enio Chaves

doi:10.1590/S0034-70942004000400013

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Manuseio peri-operatório do paciente em uso de amiodarona

Peri-operative management of amiodarone patients

Gilson Ramos; José Ramos Filho; Edisio Pereira; Salustiano Gabriel Neto; Enio Chaves

http://dx.doi.org/10.1590/S0034-70942004000400013 Braz J Anesthesiol, vol.54, n4, p.573-581, 2004

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Resumo

JUSTIFICATIVA E OBJETIVOS: A amiodarona é um antidisrítmico bastante eficaz e indicado no tratamento de disritmias ventriculares e supraventriculares, motivo pelo qual vem sendo extensamente administrada na prática clínica. Entretanto, seu uso crônico pode estar associado com sérios efeitos colaterais, que podem ser agravados por atos anestésico-cirúrgicos, aumentando o risco dos procedimentos. O presente estudo objetiva revisar os principais efeitos da amiodarona e associá-los à prática clínica do anestesiologista. CONTEÚDO: Tratou-se das principais propriedades da amiodarona, seu uso clínico, bem como os mais importantes efeitos adversos que podem aumentar o risco cirúrgico dos pacientes em uso desse antidisrítmico. CONCLUSÕES: A amiodarona, apesar de habitualmente segura e eficiente, pode apresentar efeitos adversos exacerbados, notadamente para o aparelho cardiovascular, durante procedimentos anestésico-cirúrgicos. Isso se deve possivelmente às interações entre esse fármaco e agentes anestésicos, associados principalmente à anestesia geral. Há relatos de bradicardias graves e resistentes à terapêutica, bem como bloqueio atrioventricular (BAV) em graus variados. O paciente deve ser rigorosamente monitorizado, especialmente nos procedimentos de grande porte, e o anestesiologista deve estar amparado no peri-operatório com drogas vasoativas (isoproterenol) e marcapasso cardíaco artificial temporário, que podem ser fundamentais durante o procedimento.

Palavras-chave

COMPLICAÇÕES, COMPLICAÇÕES, COMPLICAÇÕES, COMPLICAÇÕES, COMPLICAÇÕES, DROGAS

Abstract

BACKGROUND AND OBJECTIVES: Amiodarone is quite an effective anti-arrhythmic drug indicated for controlling ventricular and supra-ventricular arrhythmias, and it is being widely administered in clinical practice. However, its chronic use may be associated to severe side effects which may be worsened by anesthetic-surgical acts, thus increasing the risk of such procedures. This study aimed at reviewing major amiodarone effects and relating them to anesthetic procedures. CONTENTS: The study covers major amiodarone properties, its clinical use, as well as major adverse effects, which may increase patient's surgical risk. CONCLUSIONS: Amiodarone, although normally safe and effective, may present adverse effects, especially on cardiovascular system, during anesthetic-surgical procedures. This is possibly due to interactions between this drug and anesthetic agents mainly related to general anesthesia. There are reports on severe, treatment - resistant bradycardias as well as on different degrees of atrioventricular block (AVB). Patients should be carefully monitored, especially during major procedures, and vasoactive drugs (isoproterenol) and temporary artificial pacemaker, should be available because they may be critical during the adverse effects treatment.

Keywords

COMPLICATIONS, COMPLICATIONS, COMPLICATIONS, COMPLICATIONS, COMPLICATIONS, DRUGS

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Manuseio peri-operatório do paciente em uso de amiodarona

Peri-operative management of amiodarone patients

Gilson Ramos; José Ramos Filho; Edisio Pereira; Salustiano Gabriel Neto; Enio Chaves

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