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

Referências

Singh BN. Amiodarone: Electropharmacologic Properties. Antiarrythmic Drugs. 1989:335-364.

Ikeda N, Nademanee K, Kannan R. Electrophysiologic effects of amiodarone: experimental and clinical observation relative to serum and tissue drug concentrations. Am Heart J. 1984;108:890 -898.

Podrid PJ. Amiodarone: reevaluation of an old drug. Ann Intern Med. 1995;122:689-700.

Gallagher JD. Class III Antiarrythmic Agents: Bretylium, Sotalol, Amiodarone. Clinical Cardiac Electrophysiology: Perioperative Considerations. 1996:1247-1264.

Haffajee CI, Love JC, Canada AT. Clinical pharmacokinetics and efficacy of amiodarone for refractory tachyarrhythmias. Circulation. 1983;67:1347-1355.

Moreira DAR, Gizzi JC. Antiarrímicos: Grupos II e III. Farmacologia e Terapêutica Cardiovascular. 1999:475-500.

Belzer JR. The rational use of intravenous amiodarone in the perioperative period. Anesthesiology. 1997;86:974-987.

Burns KE, Piliotis E, Garcia BM. Amiodarone pulmonary, neuromuscular and ophthalmological toxicity. Can Respir J. 2000;7:193-197.

Mason JW. Amiodarone. N Engl J Med. 1987;316:455-466.

Stoetink RK. Cardiac Antidysrhythmic Drugs. Pharmacology and Physiology in Anesthetic Practice. 1987:322-334.

Rooney RT, Marijic J, Stommel KA. Additive cardiac depression by volatile anesthetics in isolated hearts after chronic amiodarone treatment. Anesth Analg. 1995;80:917-924.

Gallagher JD, Lieberman RW, Meranze J. Amiodarone-induced complications during coronary artery surgery. Anesthesiology. 1981;55:186-188.

Navalgund AA, Alifimoff JK, Jakymec AJ. Amiodarone-induced sinus arrest successfully treated with ephedrine and isoproterenol. Anesth Analg. 1986;65:414-416.

White CM, Dunn A, Tsikouris J. An assessment of the safety of short-term amiodarone therapy in cardiac surgical patients with fentanyl-isoflurane anesthesia. Anesth Analg. 1999;89:585-589.

Ben-David J, Zipes DP. Torsades de Pointes and proarrhythmia. Lancet. 1993;341:1578-1582.

Liberman BA, Teasdale SJ. Anaesthesia and amiodarone. Can Anaesth Soc J. 1985;32:629-638.

Dyck M, Baele P, Rennotte MT. Should amiodarone be discontinued before cardiac surgery?. Acta Anaesthesiol Belg. 1988;39:3-10.

Perkins MW, Dasta JF, Reilley TE. Intraoperative complications in patients receiving amiodarone: characteristics and risk factors. DICP. 1989;23:757-763.

Chassard D, George M, Guiraud M. Relationship between preoperative amiodarone treatment and complications observed during anaesthesia for valvular cardiac surgery. Can J Anaesth. 1990;37:251-254.

Claxton S, Sinha SN, Donovan S. Refractory amiodarone-associated thyrotoxicosis: an indication for thyroidectomy. Aust N Z J Surg. 2000;70:174-178.

Rouleau F, Baudusseau O, Dupuis JM. Incidence and timing of thyroid dysfunction with long-term amiodarone therapy. Arch Mal Coeur Vaiss. 2001;94:39-43.

Hilleman D, Miller MA, Parker R. Optimal management of amiodarone therapy: efficacy and side effects. Pharma- cotherapy. 1998;18:138S-145S.

Wilson JS, Podrid PJ. Side effects from Amiodarone. Am Heart J. 1991;121:158-171.

Harjai KJ, Licata AA. Effects of amiodarone on thyroid function. Ann Intern Med. 1997;126:63-73.

Loh KC. Amiodarone-induced thyroid disorders: a clinical review. Postgrad Med J. 2000;76:133-140.

Meurisse M, Gollogly L, Degauque C. Iatrogenic thyrotoxicosis: causal circumstances, pathophysiology, and principles of treatment-review of the literature. World J Surg. 2000;24:1377-1385.

Sutherland J, Robinson B, Delbridge L. Anaesthesia for amiodarone-induced thyrotoxicosis: a case review. Anaesth Intensive Care. 2001;29:24-29.

Bogazzi F, Miccoli P, Berti P. Preparation with iopanoic acid rapidly controls thyrotoxicosis in patients with amiodarone-induced thyrotoxicosis before thyroidectomy. Surgery. 2002;132:1114-1117.

Rakita L, Sobol SM, Mostow N. Amiodarone pulmonary toxicity. Am Heart J. 1983;106:906-916.

Dusman RE, Stanton MS, Miles WM. Clinical features of amiodarone-induced pulmonary toxicity. Circulation. 1990;82:51-59.

Pollak PT. Clinical organ toxicity of antiarrhythmic compounds: ocular and pulmonary manifestations. Am J Cardiol. 1999;84:37R-45R.

Harris L, McKenna WJ, Rowland E. Side effects of long-term amiodarone therapy. Circulation. 1983;67:45-51.

Richer M, Robert S. Fatal hepatotoxicity following oral administration of amiodarone. Ann Pharmacother. 1995;29:582-586.

Feher J, Vasarhelyi B, Blazovics A. Halothane hepatitis. Orv Hetil. 1993;134:1795-1798.

Weitz J, Kienle P, Bohrer H. Fatal hepatic necrosis after isoflurane anaesthesia. Anaesthesia. 1997;52:892-895.

Martinez-Arizala A, Sobol SM, McCarty GE. Amiodarone neuropathy. Neurology. 1983;33:643-645.

Besser R, Treese N, Bohl J. Clinical, neurophysiologic and biopsy findings in neurotoxic amiodarone syndrome. Med Klin. 1994;89:367-372.

Palakurthy PR, Iyer V, Meckler RJ. Unusual neurotoxicity associated with amiodarone therapy. Arch Intern Med. 1987;147:881-884.

Miller B, Skupin A, Rubenfire M. Respiratory failure produced by severe procainamide intoxication in a patient with preexisting peripheral neuropathy caused by amiodarone. Chest. 1988;94:663-665.

Gepner P, Botto H, Piette AM. Hypothyroid myopathy: apropos of a case with a great increase of creatine phosphokinase, myoglobinemia and transient kidney failure. Rev Med Interne. 1990;11:165-167.

Silva Oropeza E, Peralta Rosado HR, Valero Elizondo C. A case of amiodarone and neuromyopathy. Rev Invest Clin. 1997;49:135-139.

Baur CP, Schlecht R, Jurkat-Rott K. Anesthesia in neuromuscular disorders. Part 1: introduction. Anaesthesiol Intensivmed Notfallmed Schmerzther. 2002;37:77-83.

Gascon MP, Dayer P, Waldvogel F. Drug interactions of midazolam. Schweiz Med Wochenschr. 1989;119:1834-1836.

Siegmund JB, Wilson JH, Imhoff TE. Amiodarone interaction with lidocaine. J Cardiovasc Pharmacol. 1993;21:513-515.

Martinowitz U, Rabinovich J, Goldfarb D. Interaction between warfarin sodium and amiodarone. N Engl J Med. 1981;304:671-672.

Frishman WH, Sonnenblick EH. Beta-Adrenergic Blocking Drugs. Hurst' s The Heart. 1994;1:1271-1290.

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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