Anestesia venosa total em regime de infusão alvo-controlada: uma análise evolutiva

Fernando Squeff Nora

doi:10.1590/S0034-70942008000200011

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Anestesia venosa total em regime de infusão alvo-controlada: uma análise evolutiva

Total intravenous anesthesia as a target-controlled infusion: an evolutive analysis

Fernando Squeff Nora

http://dx.doi.org/10.1590/S0034-70942008000200011 Braz J Anesthesiol, vol.58, n2, p.179-192, 2008

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JUSTIFICATIVA E OBJETIVOS: A anestesia venosa total (AVT) sofreu diversos avanços desde o início da utilização da técnica. Desde a síntese dos primeiros anestésicos venosos, com a introdução dos barbitúricos (1921) e do tiopental (1934), a AVT evoluiu até o desenvolvimento da AVT com auxílio de bombas com infusão alvo-controlada (IAC). O primeiro modelo farmacocinético para uso em IAC foi descrito por Schwilden em 1981. Foi demonstrado, a partir daí, que era possível manter a concentração plasmática desejada de um fármaco utilizando-se bomba de infusão gerenciada por computador. CONTEÚDO: Este artigo visou a descrever as bases teóricas da IAC, a apresentar uma proposta de desenvolvimento de um vocabulário comum em IAC ainda não publicado no Brasil e a fazer uma análise crítica dos aspectos atuais da IAC no mundo e no Brasil. CONCLUSÕES: A chegada de novas bombas de infusão dotadas dos modelos farmacocinéticos do remifentanil, sufentanil e propofol inaugura outro capítulo da AVT e alinha o Brasil com a tendência mundial em IAC. Esses sistemas possibilitarão a IAC de hipnóticos e opióides concomitantemente. A conclusão mais importante, no entanto, refere-se à economia à medida que os fármacos utilizados nessas bombas não ficarão restritos apenas a uma empresa farmacêutica, a exemplo do que ocorreu com o propofol. Hoje já se dispõe de equipamentos para utilização de propofol e opióides, em IAC, que aceitam qualquer apresentação farmacêutica com a vantagem da possibilidade de alteração da concentração do fármaco na seringa, de acordo com a diluição desejada.

Palavras-chave

ANESTESIA, Geral

Abstract

BACKGROUND AND DOBJECTIVES: Total intravenous anesthesia (TIVA) has seen several developments since it was first used. Since the synthesis of the first intravenous anesthetics, with the introduction of barbiturates (1921) and thiopental (1934), TIVA has evolved until the development of TIVA with target-controlled infusion pumps (TCI). The first pharmacokinetic model for the use of TCI was described by Schwilden in 1981. From that moment on, it was demonstrated that it is possible to maintain the desired plasma concentration of a drug using an infusion pump managed by a computer. CONTENTS: The objective of this report was to describe the theoretical bases of TCI, propose the development of a common TCI vocabulary, which has not been done in Brazil and make a critical analysis of the current aspects of TCI in the world and in Brazil. CONCLUSIONS: The advent of new infusion pumps with pharmacokinetic models of remifentanil, sufentanil and propofol opens a new chapter in TIVA and aligns Brazil with the world tendency in TCI. Those systems will allow TCI of hypnotics and opioids concomitantly. However, the most important conclusion refers to the economy, since drugs used in those pumps will not be restricted to only one drug company, similar to what happened with propofol. Nowadays, TCI devices for the use of propofol and opioids, which accept any pharmaceutical presentation, with the advantage of changing the concentration of the drug in the syringe according to the dilution desired are available.

Keywords

ANESTHESIA, General

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Anestesia venosa total em regime de infusão alvo-controlada: uma análise evolutiva

Total intravenous anesthesia as a target-controlled infusion: an evolutive analysis

Fernando Squeff Nora

Resumo

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Abstract

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