Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942005000500012
Brazilian Journal of Anesthesiology
Review Article

Proteção miocárdica em cirurgia cardíaca

Myocardial protection in cardiac surgery

Luiz Marcelo Sá Malbouisson; Luciana Moraes dos Santos; José Otávio Costa Auler Jr; Maria José Carvalho Carmona

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Resumo

JUSTIFICATIVA E OBJETIVOS: A proteção miocárdica define o conjunto de estratégias que objetivam atenuar a intensidade da lesão de isquemia-reperfusão miocárdica durante a cirurgia cardíaca e suas conseqüências sobre a função miocárdica. Um melhor entendimento dos fenômenos fisiopatológicos relacionados à isquemia-reperfusão miocárdica e da cardioproteção promovida por determinados fármacos e técnicas anestésicas tem dado ao anestesiologista papel importante na proteção miocárdica durante o procedimento cirúrgico. O objetivo desta revisão foi abordar os mecanismos de lesão miocárdica e as modalidades de proteção miocárdica com enfoque para a técnica anestésica. CONTEÚDO: São abordados os mecanismos de lesão miocárdica durante os eventos de isquemia-reperfusão e suas conseqüências clínicas assim como às técnicas de proteção realizadas durante a cirurgia cardíaca. Ênfase especial é dada aos fármacos e técnicas anestésicas, como anestésicos halogenados, opióides e fármacos adjuvantes, pois estes têm mostrado efeitos cardioprotetores em cirurgia cardíaca. CONCLUSÕES: A associação de técnica anestésica adequada com agentes anestésicos cardioprotetores às técnicas habituais de proteção miocárdica realizadas pelo cirurgião pode contribuir para prevenção de disfunção miocárdica e promover melhor recuperação no período pós-operatório.

Palavras-chave

ANALGÉSICOS, ANESTÉSICOS, CIRURGIA, COMPLICAÇÕES, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Myocardial protection defines the set of strategies aiming at attenuating the intensity of myocardial ischemia-reperfusion injury during heart surgery and its harmful consequences on myocardial function. A better understanding of pathophysiological phenomena related to ischemia-reperfusion events and of the anesthetic-induced heart protection has given to the anesthesiologist a major role in intraoperative myocardial protection. The objective of this update was to review the mechanisms of ischemia-reperfusion-induced myocardial injury and myocardial protection modalities focusing on anesthetic techniques. CONTENTS: Ischemia-reperfusion-induced myocardial injury mechanisms and their clinical consequences on heart as well as myocardial protection techniques used during heart surgery are addressed in this review. Special emphasis is given to the role of anesthetic drugs and techniques such as inhaled halogenate anesthetics, opioids and adjuvant anesthetic drugs, since they have been shown to have heart protecting effects during cardiac surgery. CONCLUSIONS: The association of adequate anesthetic technique using heart protecting agents to usual myocardial protection modalities performed by the surgeon may contribute to the prevention of cardiac surgery-induced myocardial dysfunction and improve postoperative outcome.

Keywords

ANALGESICS, ANESTHETICS, COMPLICATIONS, COMPLICATIONS, SURGERY

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