Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942006000500001
Brazilian Journal of Anesthesiology
Scientific Article

Regressão da anestesia geral em pacientes com paralisia cerebral: estudo comparativo utilizando o índice bispectral

Regression of general anesthesia in patients with cerebral palsy: a comparative study using the bispectral index

Verônica Vieira da Costa; Renato Ângelo Saraiva; Leonardo Teixeira Domingues Duarte

http://dx.doi.org/10.1590/S0034-70942006000500001 Braz J Anesthesiol, vol.56, n5, p.431-442, 2006
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Resumo

JUSTIFICATIVA E OBJETIVOS: É descrito que os pacientes com paralisia cerebral (PC) são mais sensíveis aos agentes anestésicos que poderia comprometer o despertar da anestesia. O objetivo deste estudo foi avaliar a recuperação de pacientes com PC comparada com pacientes sem doença do SNC. MÉTODO: Participaram do estudo crianças de 5 a 15 anos, divididas em dois grupos: com diagnóstico de paralisia cerebral e sem doença do SNC. Todas foram submetidas à anestesia geral com sevoflurano associado a óxido nitroso e oxigênio a 50%. Além da monitorização habitualmente empregada, foram monitorizadas com o EEG-BIS. Durante o despertar da anestesia, a extubação traqueal e o pós-anestésico imediato, foi avaliada a regressão da anestesia segundo os critérios adotados por Saraiva. Avaliou-se também a velocidade de eliminação dos agentes anestésicos correlacionando-a com os valores de EEG-BIS e comparando os dois grupos de pacientes. A análise estatística foi realizada por meio da análise exploratória de dados e teste estatístico para comparação de médias, considerando como diferença estatística significativa o valor de p menor ou igual a 5%. RESULTADOS: Foram avaliados 56 pacientes, sendo 31 com PC e 25 sem doença do SNC. Os grupos foram homogêneos com relação à idade e ao sexo. O valor do EEG-BIS basal dos pacientes com PC foi menor do que o grupo-controle, com diferença estatística significativa (p = 0,04). Nos cinco primeiros minutos após a interrupção do sevoflurano, o valor do EEG-BIS dos pacientes com PC apresentou elevação mais lenta com relação ao controle. A velocidade de eliminação do agente anestésico foi semelhante nos dois grupos. Aos 15 minutos, 48% dos pacientes do grupo-controle estavam no estágio III de regressão anestésica, versus 29% do grupo com paralisia cerebral. Aos 30 minutos, 72% dos pacientes do grupo-controle estavam aptos para receber alta, no estágio IV de regressão anestésica, versus 41,9% dos pacientes com PC. CONCLUSÕES: Os pacientes com paralisia cerebral apresentaram retorno mais lento da consciência em comparação com o grupo-controle.

Palavras-chave

ANESTESIA, Geral, DOENÇAS, Neurológica, RECUPERAÇÃO PÓS-ANESTÉSICA

Abstract

BACKGROUND AND OBJECTIVES: It has been said that patients with cerebral palsy (CP) present a higher sensitivity to anesthetic agents, which may affect adversely the awakening from anesthesia. The objective of this study was to evaluate the recovery of patients with CP compared with patients without CNS disease. METHODS: The study population was composed of children ages 5 to 15, divided in two groups: those with a diagnosis of cerebral palsy and those without CNS disease. All of them underwent general anesthesia with sevoflurane associated with nitrous oxide and 50% oxygen. Besides the parameters commonly monitored, they also underwent EEG-BIS monitoring. Regression of general anesthesia during awakening from anesthesia, tracheal extubation, and the immediate postanesthetic period were evaluated according to the criteria adopted by Saraiva. The speed of elimination of the anesthetic agents was also evaluated, correlating it with the EEG-BIS values, and comparing the two groups of patients. Statistical analysis was done through exploratory analysis of the data and statistical testing comparing the means. The statistical difference was considered significant for values of p smaller or equal to 5%. RESULTS: Fifty-six patients were evaluated: 31 with CP and 25 without CNS disease. Both groups were homogenous regarding age and gender. Baseline EEG-BIS values for CP patients were smaller than those for the control group, and this difference was statistically significant (p = 0.04). During the first five minutes after discontinuation of sevoflurane, the elevation of the EEG-BIS values for CP patients was slower than for the control group. The speed of elimination of the anesthetic agent was similar in both groups. At 15 minutes, 48% of the patients in the control group were in stage II of anesthetic regression versus 29% of the patients with cerebral palsy. At 30 minutes, 72% of the patients in the control group were in condition to be discharged, in stage IV of anesthetic regression, versus 41.9% of the patients with CP. CONCLUSIONS: Patients with cerebral palsy presented a slower return to the conscious state when compared with patients in the control group.

Keywords

ANESTHESIA, General, DISEASES, Neurological, POSTANESTHETIC RECOVERY

Referencias

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