Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942009000200001
Brazilian Journal of Anesthesiology
Scientific Article

Anestesia venosa total em infusão alvo-controlada associada a bloqueio do nervo femoral para meniscectomia do joelho por acesso artroscópico

Target-controlled total intravenous anesthesia associated with femoral nerve block for arthroscopic knee meniscectomy

Fernando Squeff Nora

http://dx.doi.org/10.1590/S0034-70942009000200001 Braz J Anesthesiol, vol.59, n2, p.131-141, 2009
PDF Português
PDF English
Downloads: 1
Views: 1482

Resumo

JUSTIFICATIVA E OBJETIVOS: O aumento da popularidade de técnicas operatórias minimamente invasivas reduziu os tempos de recuperação de procedimentos que, anteriormente, eram associados a período de internação longo. Este trabalho apresenta técnica de anestesia geral venosa total com propofol e remifentanil combinada a bloqueio do nervo femoral, por acesso perivascular inguinal. MÉTODO: Foram incluídos 90 pacientes submetidos à artroscopia do joelho para meniscectomias. A indução anestésica foi feita com propofol em infusão alvo-controlada (IAC) (alvo = 4 µg.mL-1) e com remifentanil em IAC (alvo = 3 ng.mL-1). As alterações das concentrações de propofol e remifentanil eram realizadas de acordo com a eletroencefalografia bispectral (BIS) e a pressão arterial média (PAM). A ventilação era mecânica e controlada a volume e a via aérea mantida com máscara laríngea. Os valores das concentrações no local efetor de propofol e remifentanil eram obtidos através dos modelos farmacocinéticos dos fármacos, inseridos nas bombas de IAC e corresponderam a concentrações preditivas. Local efetor refere-se à área de ação dos fármacos. O tempo de alta hospitalar compreendeu o espaço de tempo entre a chegada do paciente na sala de recuperação até o momento da alta. RESULTADOS: As concentrações médias no local efetor (ng.mL-1), máximas e mínimas, de remifentanil foram de 3,5 e 2,4, respectivamente. As concentrações médias no local efetor (µg.mL-1), máximas e mínimas de propofol, foram respectivamente de 3,1 e 2,6. A vazão média de infusão de propofol e de remifentanil foi de 8,54 mg.kg-1.h-1 e de 0,12 µg.kg-1.min-1 , respectivamente. Os tempos de alta hospitalar foram, em média, de 180min. CONCLUSÕES: Todos os pacientes foram mantidos dentro dos parâmetros estabelecidos.

Palavras-chave

ANESTESIA, Geral, ANESTÉSICO, Venoso, ANESTÉSICO, Venoso, CIRURGIA, Ortopédica, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: The increased popularity of minimally invasive surgical techniques reduced recovery time of procedures that were usually associated with prolonged hospitalization. This study reports the technique of total intravenous anesthesia with propofol and remifentanil associated with femoral nerve block using the inguinal perivascular approach. METHODS: Ninety patients undergoing knee arthroscopy for meniscectomy were included in this study. Target-controlled infusion (TCI) of propofol (target = 4 µg.mL-1) and remifentanil (target = 3 ng.mL-1) was used for induction of anesthesia. The concentrations of propofol and remifentanil were changed according to the bispectral index (BIS) and mean arterial pressure (MAP). Volume-controlled mechanical ventilation with a laryngeal mask was used. The concentrations of propofol and remifentanil at the effector site, corresponding to the predictive concentrations, were obtained using the pharmacokinetic models of the drugs inserted in the TCI pumps. Time for hospital discharge encompassed the period between the moment the patient arrived at the recovery room and hospital discharge. RESULTS: Maximal and minimal mean concentrations at the effector site (ng.mL-1) of remifentanil were 3.5 and 2.4, respectively. Maximal and minimal mean concentrations of propofol at the effector site (µg.mL-1) were 3.1 and 2.6, respectively. The mean flow of infusion of propofol and remifentanil was 8.54 mg.kg-1.h-1 and 0.12 µg.kg-1.min-1, respectively. Mean hospital discharge time was 180 min. CONCLUSIONS: All patients were maintained within established parameters.

Keywords

ANESTHESIA, General, ANESTHETIC, Intravenous, ANESTHETIC, Intravenous, ANESTHETIC TECHNIQUES, Regional, SURGERY, Orthopedic

References

White PF. Ambulatory anesthesia advances into the new millennium. Anesth Analg. 2000;90:1234-1235.

Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183:630-641.

White PF, Eng M. Fast-track anesthetic techniques for ambulatory surgery. Curr Opin Anaesthesiol. 2007;20:545-557.

Sá Rego MM, Watcha MF, White PF. The changing role of monitored anesthesia care in the ambulatory setting. Anesth Analg. 1997;85:1020-1036.

Twersky RS, Sapozhnikova S, Toure B. Risk factors associated with fast-track ineligibility after monitored anesthesia care in ambulatory surgery patients. Anesth Analg. 2008;106:1421-1426.

Chung F, Ritchie E, Su J. Postoperative pain in ambulatory surgery. Anesth Analg. 1997;85:808-816.

Anderson FH, Nielsen K, Kehlet H. Combined illioinguinal blockade and local infiltration anaesthesia for groin hernia repair: a double-blind randomized study. Br J Anaesth. 2005;94:520-523.

Callesen T, Bech K, Kehlet H. One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia. Anesth Analg. 2001;93:1373-1376.

Kehlet H, White PF. Optimizing anesthesia for inguinal herniorraphy: general, regional or local anesthesia?. Anesth Analg. 2001;93:1367-1369.

Hadzic A, Karaca PE, Hobeika P. Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy. Anesth Analg. 2005;100:976-981.

Moiniche S, Mikkelsen S, Wetterslev J. A systematic review of intra-articular local anesthesia for postoperative pain relief after arthroscopic knee surgery. Reg Anesth Pain Med. 1999;24:430-437.

Gupta A. Evidence-based medicine in day surgery. Curr Opin Anaesthesiol. 2007;20:520-525.

Nora FS. Anestesia venosa total em regime de infusão alvo-controlada: Uma análise evolutiva. Rev Bras Anestesiol. 2008;58:179-192.

Ben-David B, DeMeo PJ, Lucyk C. A comparison of minidose lidocaine-fentanyl spinal anesthesia and local anesthesia/propofol infusion for outpatient knee arthroscopy. Anesth Analg. 2001;93:319-325.

Sá Rêgo MM, White PF. What is new in monitored anesthesia care?. Curr Opin Anaesthesiol. 1998;11:601-606.

Berkenstadt H, Perel A, Hadani . Monitored anesthesia care using remifentanil and propofol for awake craniotomy. J Neurosurg Anesthesiol. 2001;13:246-249.

Snyder SK, Roberson CR, Cummings CC. Local anesthesia with monitored anesthesia care vs general anesthesia in thyroidectomy: a randomized study. Arch Surg. 2006;141:167-173.

5dd686650e88253a48c8fca6 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections