Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000400006
Brazilian Journal of Anesthesiology
Scientific Article

Indução anestésica após o tratamento do choque hemorrágico: estudo experimental comparando a cetamina e o etomidato

Anesthetic induction after treated hemorrhagic shock: experimental study comparing ketamine and etomidate

Adilson O. Fraga; Luiz Marcelo Sá Malbouisson; Ricardo Prist; Maurício Rocha e Silva; José Otávio Costa Auler Júnior

http://dx.doi.org/10.1590/S0034-70942006000400006 Braz J Anesthesiol, vol.56, n4, p.377-390, 2006
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Resumo

JUSTIFICATIVA E OBJETIVOS: O sangramento que leva ao choque hemorrágico geralmente necessita tratamento cirúrgico sob anestesia geral. Por sua vez, os anestésicos podem comprometer ainda mais as condições hemodinâmicas. O objetivo deste estudo foi o de comparar os efeitos hemodinâmicos da cetamina e do etomidato durante a indução anestésica em cães submetidos a um modelo experimental de choque hemorrágico e reanimação. MÉTODO: Trinta e dois cães mestiços foram submetidos ao choque hemorrágico pressão-controlado, reanimação e indução anestésica. Após atingir a pressão alvo de 40 mmHg eles foram divididos aleatoriamente em dois grupos de acordo com a solução usada na reanimação: NaCl a 0.9% (32 ml.kg-1) e NaCl a 7,5% (4 mL.kg-1). Após a infusão de volume, esses grupos foram divididos novamente de acordo com o anestésico utilizado: GI) NaCl a 0.9% e cetamina; GII) NaCl a 7.5% e cetamina; GIII) NaCl a 0.9% e etomidato; e GIV) NaCl a 7.5% e etomidato. Medições hemodinâmicas foram obtidas em cinco momentos: (M0) inicial; (M1) após o desenvolvimento do choque hemorrágico; (M2) após a administração de fluidos; (M3) 5 minutos após a indução anestésica; (M4) 15 minutos após a indução anestésica. Foi feita a análise estatística usando o teste t de Student e two-way ANOVA. Foram considerados significativos valores de p menores do que 0,05. RESULTADOS: Após a instalação do choque, ambas as soluções restabeleceram os padrões hemodinâmicos aos valores iniciais. Independente do anestésico ou da solução utilizados, após a indução anestésica a pressão arterial média permaneceu inalterada em todos os grupos. A pressão venosa central, freqüência cardíaca, pressão capilar pulmonar e o índice de resistência pulmonar vascular aumentaram significativamente após a administração de cetamina. O índice cardíaco, o índice de resistência vascular sistêmica e o transporte de oxigênio permaneceram estáveis em todos os grupos. CONCLUSÕES: O etomidato ou a cetamina foram capazes de manter a estabilidade hemodinâmica nos cães que sofreram choque hemorrágico intenso e que foram tratados com NaCl a 0,9% ou NaCl a 7,5%.

Palavras-chave

ANIMAIS, COMPLICAÇÕES, DROGAS, TERAPÊUTICA, VOLEMIA

Abstract

BACKGROUND AND OBJECTIVES: Bleeding causing hemorrhagic shock usually requires surgical treatment under general anesthesia. Anesthetic drugs may further compromise hemodynamics. The objective was to compare the hemodynamic effects of ketamine and etomidate during anesthetic induction in dogs submitted to an experimental model of hemorrhagic shock and resuscitation. METHODS: Thirty-two mongrel dogs were submitted to a pressure-controlled hemorrhagic shock, resuscitation and anesthetic induction model. After achieving the target pressure of 40 mmHg, they were randomly assigned in two groups according to the resuscitation fluid to be used: NaCl 0.9% (32 mL.kg-1) and NaCl 7.5% (4 mL.kg-1). After volume infusion, these groups were reassigned according to anesthetic drug used: GI) NaCl 0.9% and ketamine; GII) NaCl 7.5% and ketamine; GIII) NaCl 0.9% and etomidate; and GIV) NaCl 7.5% and etomidate. Hemodynamic measurements were obtained at five moments: (M0) baseline; (M1) after bleeding to shock; (M2) after volume expansion; (M3) 5 minutes after anesthetic induction; (M4) 15 minutes after anesthetic induction. Statistical analysis was performed using Student t test and two way ANOVA. Value of p lower than 0.05, was considered significant. RESULTS: After shock, both solutions restored hemodynamics to baseline values. Independently of anesthetic agent or expansion solution used, mean arterial pressure remained unaltered for all groups after induction. Central venous pressure, heart rate, pulmonary capillary wedge pressure and pulmonary vascular resistance index increased significantly after ketamine infusion. Cardiac index, systemic vascular resistance index and oxygen transport variables remained stable in all groups. CONCLUSIONS: Etomidate or ketamine were able to maintain hemodynamic stability in dogs undergoing severe hemorrhagic shock treated with NaCl 0.9% or NaCl 7.5%.

Keywords

ANIMALS, COMPLICATIONS, DRUGS, THERAPEUTIC, VOLEMIA

Referencias

Krausz MM. Controversies in shock research: hypertonic resuscitation - pros and cons. Shock. 1995;3:69-72.

Moss GS, Gould AS. Plasma expanders: an update. Am J Surg. 1988;155:425-434.

Krausz MM, Bashenko Y, Hirsh M. Crystalloid and colloid resuscitation of uncontrolled hemorrhagic shock following massive splenic injury. Shock. 2001;16:383-388.

Shi HP, Deitch EA, Da Xu Z. Hypertonic saline improves intestinal mucosa barrier function and lung injury after trauma-hemorrhagic shock. Shock. 2002;17:496-501.

de Felippe J Jr, Timoner J, Velasco IT. Treatment of refractory hypovolemic shock by 7.5% sodium chloride injections. Lancet. 1980;2.

Paes da Silva F, Gonzalez AP, Tibirica E. Effects of fluid resuscitation on mesenteric microvascular blood flow and lymphatic activity after severe hemorrhagic shock in rats. Shock. ;19:55-60.

Plewa MC, King R, Johnson D. Etomidate use during emergency intubation of trauma patients. Am J Emerg Med. 1997;15:98-100.

Haskins SC, Patz JD. Ketamine in hypovolemic dogs. Crit Care Med. 1990;18:625-629.

Pascoe PJ, Ilkiw JE, Haskins SC. Cardiopulmonary effects of etomidate in hypovolemic dogs. Am J Vet Res. 1992;53:2178-2182.

Gelissen HP, Epema AH, Henning RH. Inotropic effects of propofol, thiopental, midazolam, etomidate, and ketamine on isolated human atrial muscle. Anesthesiology. 1996;84:397-403.

Prist R, Rocha e Silva M, Velasco IT. Pressure-driven hemorrhage: a new experimental design for the study of crystalloid and small-volume hypertonic resuscitation in anesthetized dogs. Circ Shock. 1992;36:13-20.

Priano LL, Vatner SF. Morphine effects on cardiac output and regional blood flow distribution in conscious dogs. Anesthesiology. 1981;55:236-243.

Velasco IT, Pontieri V, Rocha e Silva M Jr. Hyperosmotic NaCl and severe hemorrhagic shock. Am J Physiol. 1980;239:H664-H673.

Rocha e Silva M, Braga GA, Prist R. Physical and physiological characteristics of pressure-driven hemorrhage. Am J Physiol. 1992;263:1402-1410.

Nakayama S, Sibley L, Gunther RA. Small volume resuscitation with hypertonic saline (2400 mOsm/liter) during hemorrhagic shock. Circ Shock. 1984;13:149-159.

Prist R, Rocha e Silva M, Scalabrini A. A quantitative analysis of transcapillary refill in severe hemorrhagic hypotension in dogs. Shock. 1994;1:188-195.

Kien ND, Kramer GC, White DA. Acute hypotension caused by rapid hypertonic saline infusion in anesthetized dogs. Anesth Analg. 1991;73:597-602.

Bellezza M, Kerbaul F, Roussel L. The effect of hypertonic saline dextran solutions on hypoxic pulmonary vasoconstriction in anesthetized piglets. Eur Respir J. 2002;20:965-971.

Tweed WA, Minuck M, Mymin D. Circulatory responses to ketamine anesthesia. Anesthesiology. 1972;37:613-619.

Chen TS, Yeh FC, Chou YP. Effects of ketamine on the circulatory functions and body tissue oxygenation in dogs under normal and hypovolemic conditions. Proc Natl Sci Counc Repub China B. 1984;8:168-176.

Weiskopf RB, Bogetz MS, Roizen MF. Cardiovascular and metabolic sequela of inducing anesthesia with ketamine or thiopental in hypovolemic swine. Anesthesiology. 1984;60:214-219.

Debaene B, Goldfarb G, Braillon A. Effects of ketamine, halothane, enflurane, and isoflurane on systemic and splanchnic hemodynamics in normovolemic and hypovolemic cirrhotic rats. Anesthesiology. 1990;73:118-124.

Criado A, Maseda J, Navarro E. Induction of anaesthesia with etomidate: haemodynamic study of 36 patients. Br J Anaesth. 1980;52:803-806.

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