Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942009000500013
Brazilian Journal of Anesthesiology
Miscellaneous

O tempo e a anestesia obstétrica: da cosmologia caótica à cronobiologia

Time and obstetric anesthesia: from chaotic cosmology to chronobiology

Nilton Bezerra do Vale; Lúcio Flávio Bezerra do Vale; José Rômulo Cruz

http://dx.doi.org/10.1590/S0034-70942009000500013 Braz J Anesthesiol, vol.59, n5, p.624-647, 2009
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Resumo

JUSTIFICATIVA E OBJETIVOS: Ciclos temporais (claro/escuro; nascer/morrer, etc.) ao lado de condições ambientais (sincronizadores) influenciam a fisiologia do parto em função da existência de relógios endógenos (osciladores) que interagem com pistas sociais diuturnas. Nesta revisão foram ordenados os parâmetros anestésico-obstétricos cíclicos mais importantes no atendimento à parturiente. CONTEÚDO: Análise cronobiológica dos principais eventos da fisiopatologia obstétrica da Mulier sapiens: I) Período da embriogênese - risco de teratogênese; II) Da prematuridade ao pósdatismo: do parto eutócico à cerclagem uterina; III) A noite e o parto: maior incidência noturna do parto (facilitação fisiológica) e diurna da cesariana (opção do obstetra); IV) A lua e o parto - resultado não conclusivo; V) plantão noturno na Anestesia Obstétrica: contingência profissional de mais riscos; VI) Tempos da cesariana: retirada fetal: tempo UD (uterotomy - delivery) o mais curto possível; correção eficaz de hipotensão arterial e valorizar o tempo de jejum pré-anestésico; VII) Variação circadiana da distócia: dor; contração uterina; perda sanguínea; hipertensão arterial sistêmica (HAS); risco de alergia e asma brônquica. Na fase noturna há maior intensidade de contração e maiores riscos de hemorragia, de alergia e de asma. Em contraponto, há ausência de variação circadiana da HAS na eclâmpsia; VIII) Cronofarmacologia obstétrica: anestésicos locais, analgésicos, hipnóticos, anestésicos gerais e bloqueadores neuromusculares. A cronergia explica o pico analgésico matinal dos opioides, vespertino dos anestésicos locais e noturno dos anestésicos gerais inalatórios. CONCLUSÕES: A abordagem cronobiológica do atendimento anestésico ao parto na maternidade enfatiza a importância obstétrica da ritmicidade circadiana na humanização e segurança do parto.

Palavras-chave

ANESTESIA Obstétrica, CIRURGIA, Obstétrica, CRONOBIOLOGIA, CRONOBIOLOGIA

Abstract

BACKGROUND AND OBJECTIVES: Temporal cycles (dark/light; birth/death; etc.), along with environmental conditions (synchronizers), influence labor physiology because of the presence of endogenous clocks (oscillators) that interact with social diuturnal clues. In this review, the most important cyclic anesthetic-obstetric parameters in parturient care are listed. CONTENTS: Chronobiological analysis of the main events in the obstetric pathophysiology of Mulier sapiens: I) Embryogenesis - risk of teratogenesis; II) From prematurity to post-didacticism: from eutocic labor to cervical cerclage; III) Night and labor: higher incidence of nocturnal labor (physiological facilitation) and daylight cesarean section (choice of the obstetrician); IV) The moon and labor - non-conclusive results; V) The night shift in obstetric anesthesia: riskier professional contingency; VI) Phases of cesarean section: removal of the fetus: UD stage (uterotomy - delivery) as brief as possible; effective correction of hypotension and valorize pre-anesthetic fasting; VII) circadian variation of dystocia: pain; uterine contraction; blood loss; hypertension (HTN); risk of allergy and asthma. In the nocturnal phase, the intensity of contraction and risk of hemorrhage, allergy, and asthma are greater. On the other hand, HTN in eclampsia does not show circadian variation; VIII) Obstetric chronopharmacology: local anesthetics, analgesics, hypnotics, general anesthetics, and neuromuscular blockers. Chronoenergy explains the matinal peak of opioid analgesia, vespertine of local anesthetic, and nocturnal of inhalational anesthetics. CONCLUSIONS: The chronobiological approach of labor anesthesia emphasizes the obstetric importance of circadian rhythmicity in labor humanization and safety.

Keywords

ANESTHESIA, Obstetrics, CHRONOBIOLOGY, CHRONOBIOLOGY, SURGERY, Obstetric

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