Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000500001
Brazilian Journal of Anesthesiology
Scientific Article

Complicações respiratórias em pacientes com paralisia cerebral submetidos à anestesia geral

Respiratory complications in patients with cerebral palsy undergoing general anesthesia

Sérgio Silva de Mello; Ronaldo Soares Marques; Renato Ângelo Saraiva

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Resumo

JUSTIFICATIVA E OBJETIVOS: Anestesia em pacientes com paralisia cerebral (PC) pode representar um desafio para o anestesiologista. Este estudo prospectivo teve como objetivo determinar a prevalência e o risco de complicações respiratórias em crianças com PC submetidas à anestesia geral inalatória (AGI) para tomografia computadorizada (TC). MÉTODO: Participaram do estudo pacientes com idades entre 1 e 17 anos, estado físico ASA I a III, submetidos a AGI com sevoflurano e máscara laríngea para TC no período de junho/2002 a junho/2003, divididos em três grupos: PC tetraplégicos (PCT), outros tipos de PC (PCO) e paciente sem PC (NPC). Os pais ou responsáveis responderam a um questionário com perguntas sobre o histórico médico dos pacientes, infecção de vias aéreas superiores (IVAS), asma, convulsão, incoordenação orofaríngea, refluxo gastroesofágico, etc. Dados sobre incidência e gravidade das complicações respiratórias foram coletados prospectivamente (tosse, broncoespasmo, laringoespasmo, hipoxemia, aspiração). A amostra foi calculada para uma incidência esperada de 5% no grupo NPC, com uma diferença de 15% entre os grupos (alfa = 0,05 e beta = 0,1), utilizando-se os testes do Qui-quadrado, exato de Fisher e t de Student. RESULTADOS: Compuseram a amostra 290 pacientes divididos nos grupos da seguinte forma: PCT - 100, PCO - 79 e NPC - 111. Não houve diferença na prevalência de complicações respiratórias entre os grupos PCT (4%), PCO (8,9%) e NPC (7,3%). Houve associação entre a presença de IVAS e a ocorrência de complicações (risco relativo, 10,71). CONCLUSÕES: Crianças com paralisia cerebral tipo tetraplegia espástica não parecem ter um risco aumentado de complicações respiratórias durante anestesia geral inalatória com sevoflurano e máscara laríngea. O estudo confirma IVAS como fator de risco para a ocorrência dessas complicações.

Palavras-chave

ANESTESIA, Geral, DOENÇAS, neurológica, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJETIVES: Anesthesia in patients with cerebral palsy (CP) poses a challenge for the anesthesiologist. The objective of this prospective study was to determine the prevalence and risk of respiratory complications in children with CP undergoing general inhalational anesthesia for computed tomography. METHODS: Patients with ages ranging from 1 to 17 years, physical status ASA I to III, undergoing general inhalational anesthesia with sevoflurane and laryngeal mask for a CT scan from June 2002 to June 2003, participated in this study. Patients were divided in 3 groups: quadriplegic CP (CPQ), other types of CP (CPO), and patients without CP (NCP). Parents or guardians answered a questionnaire that assessed the past medical history of the patient, upper respiratory infections (URI), asthma, seizures, oropharyngeal dysfunction, gastroesophageal reflux, etc. Data on the incidence and severity of respiratory complications were gathered prospectively (cough, bronchospasm, laryngeal spasm, hypoxemia, aspiration, etc). The size of the study group was calculated for an expected 5% incidence in the NCP group, with a 15% difference among groups (alpha = 0.05 and beta = 0.1), using the Chi-square test, Fisher exact test, and test t Student. RESULTS: Two hundred and ninety patients, divided in three groups, participated in this study. Groups were composed of: CPQ = 100 patients, CPO = 79 patients, and NCP = 111 patients. There were no differences on the prevalence of respiratory infections among the CPQ (4%), CPO (8.9%), and NCP (7.3%) groups. There was a correlation between the presence of URI and the development of complications (relative risk of 10.71). CONCLUSIONS: Children with cerebral palsy with spastic quadriplegia do not seem to have an increased risk of respiratory complications during general inhalational anesthesia with sevoflurane and laryngeal mask. This study confirms URI as a risk factor for the development of those complications.

Keywords

ANESTHESIA, General, COMPLICATION, DISEASES, Neurologic

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