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
PDF Português
PDF English
Downloads: 0
Views: 992

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

References

Maddox J. O Que Falta Descobrir: Explorando os segredos do universo, as origens da vida e o futuro da espécie humana. 1999:163-271.

Rosenberg KR, Trevathan WR. The Evolution of Human Birth. 2005:45-102.

Bryson B. Breve História de Quase Tudo: Do Big Bang ao Homo sapiens. 2003:247-475.

Gleiser M. A Dança do Universo: Dos Mitos da Criação ao Big Bang. 1997:17-93.

Wranghan R, Peterson D. O macho: As origens da Agressividade Humana. 1996:45-98.

Leite S. Cartas dos primeiros jesuítas do Brasil. .

Lowe NK. The nature of labor pain. Am J Obstet Gynecol. 2002;186(5^ssuppl):s16-24.

Thornton JG, Lilford RJ. Active management of labour: current knowledge and research issues. BMJ. 1994;309:366-369.

Smolensky MH, D'Alonzo GE. Medical chronobiology: concepts and applications. Am Rev Respir Dis. 1993;147:s2-19.

Aya AGM, Vialles N, Mangin R. Chronobiology of labour pain perception: an observational study. Br J Anaesth. 2004;93:451-453.

Chassard D, Bruguerolle B. Chronobiology and anesthesia. Anesthesiology. 2004;100:413-427.

Vale NB, Delfino J. As nove premissas anestesiológicas da bíblia. Rev Bras Anestesiol. 2003;53:127-136.

Gordon R. A Assustadora História da Medicina. 1996:49-103.

Greene NM. A consideration of factors in the discovery of anesthesia and their effects on its development. Anesthesiology. 1971;35:515-522.

Fink BR. Leaves and needles: the introduction of surgical local anesthesia. Anesthesiology. 1985;63:77-83.

Datta S. Common problems in obstetric anesthesia. 1995.

Caton D, Corry MP, Frigoletto FD. The nature and management of labor pain: executive summary. Am J Obstet Gynecol. 2002;186(5^ssuppl):s1-15.

Howell CJ. Epidural versus non-epidural analgesia for pain relief in labour. Cochrane Database Syst Rev. 2000;2.

Goldberg AB, Cohen A, Lieberman E. Nulliparas' preferences for epidural analgesia: their effects on actual use in labor. Birth. 1999;26:139-143.

Leboyer F. Nascer Sorrindo (Pour une naissance sans violence). 1981.

Hodnett ED. Pain and women's satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol. 2002;186(5^ssuppl):s160-172.

Huntley AL, Coon JT, Ernst E. Complementary and alternative medicine for labor pain: a systematic review. Am J Obstet Gynecol. 2004;191:36-44.

Bricker L, Lavender T. Parenteral opioids for labor pain relief: a systematic review. Am J Obstet Gynecol. 2002;186(5^ssuppl):s94-109.

Rosen MA. Nitrous oxide for relief of labor pain: a systematic review. Am J Obstet Gynecol. 2002;186(5^ssuppl):s110-126.

Brill S, Gurman GM, Fisher A. A history of neuraxial administration of local analgesics and opioids. Eur J Anaesthesiol. 2003;20:682-689.

Eddleston JM, Holland JJ, Griffin RP. A double-blind comparison of 0.25% ropivacaine and 0.25% bupivacaine for extradural analgesia in labour. Br J Anaesth. 1996;76:66-71.

Leighton BL, DeSimone CA, Norris MC. Intrathecal narcotics for labor revisited: the combination of fentanyl and morphine intrathecally provides rapid onset of profound analgesia. Anesth Analg. 1989;69:122-125.

Campbell DC, Camann WR, Datta S. The addition of bupivacaine to intrathecal sufentanil for labor analgesia. Anesth Analg. 1995;81:305-309.

Roelants F, Lavand'homme P, Mercier-Fuzier V. Epidural administration of neostigmine and clonidine to induce labor analgesia: evaluation of efficacy and local anesthetic-sparing effect. Anesthesiology. 2005;102:1205-1210.

Vale NB. Sesquicentenário da Anestesia Obstétrica. Rev Bras Anestesiol. 1998;48:424-440.

Wong CA, Scavone BM, Peaceman AM. The risk of cesarean delivery with neuraxial analgesia given early versus late in labor. N Eng J Med. 2005;352:655-665.

McCarroll CP, Paxton LD, Elliott P. Use of remifentanil in a patient with peripartum cardiomyopathy requiring caesarean section. Br J Anaesth. 2001;86:135-38.

Johanson R, Newburn M, Macfarlane A. Has the medicalisation of childbirth gone too far?. BMJ. 2002;324:892-895.

Hopkins K. Are Brazilian women really choosing to deliver by cesarean?. Soc Sci Med. 2000;51:725-740.

Sornette D. Predictability of catastrophic events: material rupture, earthquakes, turbulence, financial crashes, and human birth. Proc Natl Acad Sci USA. 2002;99(^s1):2522-2529.

Mattingly JE, D'Alessio J, Ramanathan J. Effects of obstetric analgesics and anesthetics on the neonate: a review. Paediatr Drugs. 2003;5:615-627.

Harger JH. Cerclage and cervical insufficiency: an evidence-based analysis. Obstet Gynecol. 2002;100:1313-1327.

Webb DA, Culhane J. Time of day variation in rates of obstetric intervention to assist in vaginal delivery. J Epidemiol Community Health. 2002;56:577-578.

Trap R, Helm P, Lidegaard O. Premature rupture of the fetal membranes, the phases of the moon and barometer readings. Gynecol Obstet Invest. 1989;28:14-18.

Kardong-Edgren S. Full moon, barometric pressure, and human birth. J Perinat Educ. 1995;4:21-25.

Morton-Pradhan S, Bay RC, Coonrod DV. Birth rate and its correlation with the lunar cycle and specific atmospheric conditions. Am J Obstet Gynecol. 2005;192:1970-1973.

Gaspar S, Moreno C, Menna-Barreto L. Os plantões médicos, o sono e a ritmicidade biológica. Rev Assoc Med Bras. 1998;44:239-245.

Aya AGM, Mangin R, Robert C. Increased risk of unintentional dural puncture in night-time obstetric anesthesia. Can J Anaesth. 1999;46:665-669.

Crawford JS, Lewis M, Davies P. Maternal and neonatal responses related to the volatile agent used to maintain anaesthesia at caesarean section. Br J Anaesth. 1985;57:482-487.

Ralston DH, Shnider SM, DeLorimier AA. Effects of equipotent ephedrine, metaraminol, mephentermine, and methoxamine on uterine blood flow in the pregnantg ewe. Anesthesiology. 1974;40:354-370.

Mendelson C. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynecol. 1946;52:191-205.

Lindow SW, Newham A, Hendricks MS. The 24-hour rhythm of oxytocin and beta-endorphin secretion in human pregnancy. Clin Endocrinol. 1996;45:443-446.

Dawood MY. Pharmacologic stimulation of uterine contraction. Semin Perinatol. 1995;19:73-83.

Stocche RM, Klamt JG, Antunes-Rodrigues J. Effects of intrathecal sufentanil on plasma oxytocin and cortisol concentrations in women during the first stage of labor. Reg Anesth Pain Med. 2001;26:545-550.

Decousus HA, Croze M, Levi FA. Circadian changes in anticoagulant effect of heparin infused at a constant rate. Br Med J (Clin Res Ed). 1985;290:341-344.

Nyquist PA, Brown Jr RD, Wiebers DO. Circadian and seasonal occurrence of subarachnoid and intracerebral hemorrhage. Neurology. 2001;56:190-193.

Nomura ML, Surita FGC, Parpinelli MA. Hemoglobinúria paroxística noturna e gravidez. Rev Bras Ginecol Obstet. 2004;26:579-582.

Larry CD, Yeo S. The circadian rhythm of blood pressure during pregnancy. J Obstet Gynecol Neonatal Nurs. 2000;29:500-508.

Sutherland ER, Ellison MC, Kraft M. Elevated serum melatonin is associated with the nocturnal worsening of asthma. J Allergy Clin Immunol. 2003;112:513-517.

Reinberg A, Sidi E, Ghata J. Circadian variations of adrenocortical activity and nocturnal paroxysm in asthma. Ann Endocrinol (Paris). 1963;24:452-459.

Aya AGM, Vialles N, Mangin R. Chronobiology of labour pain perception: an observational study. Br J Anaesth. 2004;93:451-453.

Viscomi CM, Rathmell JP, Pace NL. Duration of intrathecal labor analgesia: early versus advanced labor. Anesth Analg. 1997;84:1108-1112.

Zhang J, Klebanoff MA, DerSimonian R. Epidural analgesia in association with duration of labor and mode of delivery: a quantitative review. Am J Obstet Gynecol. 1999;180:970-977.

Reinberg A, Reinberg MA. Circadian changes of the duration of action of local anaesthetic agents. Naunyn Schmiedebergs Arch Pharmacol. 1977;297:149-152.

Vale NB, Silva Neto JD, Magalhães Fº EB. Anestesia subaracnoidea com bupivacaína 0,5% e lidocaína 2% isentas de glicose e em dose fixa: da eficácia/toxicidade matutina e vespertina. Rev Bras Anestesiol. 1995;45:301-308.

Debon R, Chassard D, Duflo F. Chronobiology of epidural ropivacaine: variations in the duration of action related to the hour of administration. Anesthesiology. 2002;96:542-545.

Labrecque G, Vanier MC. Biological rhythms in pain and in the effects of opioid analgesics. Pharmacol Ther. 1995;68:129-147.

DeBalli P, Breen TW. Intrathecal opioids for combined spinal-epidural analgesia during labour. CNS Drugs. 2003;17:889-904.

Pan PH, Lee S, Harris L. Chronobiology of subarachnoid fentanyl for labor analgesia. Anesthesiology. 2000;103:595-599.

Vale NB, Vale LFB, Delfino J. Variação circadiana do efeito do etomidato associado ao fentanil na anestesia para curetagem uterina. Rev Bras Anestesiol. 1999;49:227-233.

Magalhães Fº E, Menezes AAL, Capriglione M. Variação circadiana do efeito hipnótico do propofol em camundongos. Rev Bras Anestesiol. 1992;42:325-329.

Bach V, Carl P, Ravlo O. A randomized comparison between midazolam and thiopental for elective cesarean section anesthesia: III. Placental transfer and elimination in neonates. Anesth Analg. 1989;68:238-242.

Fukami N, Kotani T, Shimoji K. Circadian rhythm and anesthesia. Masui. 1970;19:1235-1238.

Cheeseman JF, Merry AF, Pawley MDM. The effect of time of day on the duration of neuromuscular blockade elicited by rocuronium. Anaesthesia. 2007;62:1114-1120.

5dd675cc0e88258816c8fca6 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