Efeitos neuromusculares e cardiovasculares do pipecurônio: estudo comparativo entre diferentes doses

Angélica de Fátima de Assunção Braga; Leandro Yoshioka; Franklin Sarmento da Silva Braga; Gloria Maria Braga Potério; José Aristeu F. Frias; Rita de Cássia Rodrigues

doi:10.1590/S0034-70942008000600003

Scientific Article

Efeitos neuromusculares e cardiovasculares do pipecurônio: estudo comparativo entre diferentes doses

Neuromuscular and cardiovascular effects of pipecuronium. A comparative study between different doses

Angélica de Fátima de Assunção Braga; Leandro Yoshioka; Franklin Sarmento da Silva Braga; Gloria Maria Braga Potério; José Aristeu F. Frias; Rita de Cássia Rodrigues

http://dx.doi.org/10.1590/S0034-70942008000600003 Braz J Anesthesiol, vol.58, n6, p.582-592, 2008

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JUSTIFICATIVA E OBJETIVOS: O pipecurônio é um bloqueador neuromuscular não-despolarizante, com propriedades similares as do pancurônio, mas desprovido de efeitos cardiovasculares. Foram avaliados os efeitos neuromusculares, as condições de intubação traqueal e as repercussões hemodinâmicas de duas diferentes doses de pipecurônio. MÉTODO: Pacientes foram distribuídos em dois grupos de acordo com a dose de pipecurônio: Grupo I (0,04 mg.kg-1) e Grupo II (0,05 mg.kg-1). A medicação pré-anestésica consistiu em midazolam (0,1 mg.kg-1) por via muscular, 30 minutos antes da operação. A indução anestésica foi obtida com propofol (2,5 mg.kg-1) precedido de fentanil (5 µg.kg-1) e pipecurônio nas doses de 0,04 e 0,05 mg.kg-1 para os Grupos I e II, respectivamente. Os pacientes foram ventilados com O2 a 100% sob máscara até a redução de 75% da amplitude da resposta a estímulo isolado (1 Hz), quando foram realizadas a laringoscopia e intubação traqueal. O isoflurano (0,5 a 1%) em mistura de O2 e N(2)0 a 50% para a manutenção da anestesia, foi introduzido logo após a intubação traqueal. Os pacientes foram ventilados mecanicamente para manter P ET CO2 entre 32 e 36 mmHg. A farmacodinâmica do pipecurônio foi avaliada por aceleromiografia. RESULTADOS: Os tempos médios e desvios-padrão para o início de ação, duração clínica (T1(25%)) e índice de recuperação (T1(25-75%)) foram: Grupo I (122,10 ± 4,18 s, 49,63 ± 9,54 min e 48,21 ± 6,72 min) e Grupo II (95,78 ± 8,91 s, 64,84 ± 13,13 min e 48,52 ± 4,95 min). O início de ação, a duração clínica e as condições de intubação traqueal foram significativamente diferentes entre os grupos. CONCLUSÕES: O pipecurônio na dose 0,05 mg.kg-1 pode ser usado em procedimentos de longa duração, nos quais é desejável evitar alterações cardiocirculatórias.

Palavras-chave

BLOQUEADORES NEUROMUSCULARES, Não-Despolarizantes, FARMACOLOGIA, FARMACOLOGIA

Abstract

BACKGROUND AND OBJECTIVES: Pipecuronium is a non-depolarizing neuromuscular blocker with similar properties to pancuronium, but without cardiovascular effects. Neuromuscular effects, conditions of tracheal intubation, and hemodynamic repercussions of two different doses of pipecuronium were evaluated.
METHOD: Patients were divided into two groups according to the dose of pipecuronium: Group I (0.04 mg.kg^-1) and Group II (0.05 mg.kg^-1). Intramuscular midazolam (0.1 mg.kg^-1) was administered 30 minutes before the surgery. Propofol (2.5 mg.kg^-1), preceded by fentanyl (5 µg.kg^-1) and pipecuronium (0.04 and 0.05 mg.kg^-1 for Groups I and II, respectively), was administered for anesthetic induction. Patients were ventilated with 100% oxygen via a face mask until a 75% reduction in the amplitude of the response to an isolated stimulus (1 Hz) is achieved, at which time laryngoscopy and intubation were carried out. Anesthetic maintenance was achieved with isoflurane (0.5 to 1%) with a mixture of 50% O₂ and N₂O. Mechanical ventilation was used to maintain P_ETCO₂ between 32 and 36 mmHg. The pharmacodynamics of pipecuronium was evaluated by acceleromyography.
RESULTS: Mean times and standard deviation for the onset of action, clinical duration (T1_25%), and recovery index (T1_25-75%) were: Group I (122.10 ± 4.18 sec, 49.63 ± 9.54 min, and 48.21 ± 6.72 min), and Group II (95.78 ± 8.91 sec, 64.84 ± 13.13 min, and 48.52 ± 4.95 min). Onset of action, clinical duration, and conditions of tracheal intubation were significantly different for both groups.
CONCLUSIONS: Pipecuronium at a dose of 0.05 mg.kg^-1 can be used in prolonged procedures in which cardiovascular changes should be avoided.

Keywords

NEUROMUSCULAR BLOCKERS, Non-depolarizing, Pipecuronium; PHARMACOLOGY: Pharmacodynamics, Pharmacokinetics.

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Efeitos neuromusculares e cardiovasculares do pipecurônio: estudo comparativo entre diferentes doses

Neuromuscular and cardiovascular effects of pipecuronium. A comparative study between different doses

Angélica de Fátima de Assunção Braga; Leandro Yoshioka; Franklin Sarmento da Silva Braga; Gloria Maria Braga Potério; José Aristeu F. Frias; Rita de Cássia Rodrigues

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