Parada cardiorrespiratória em raquianestesia

Juliana Arruda Godoy Limongi; Rossana Sant

doi:10.1590/S0034-70942011000100012

Artigo de Revisão

Parada cardiorrespiratória em raquianestesia

Cardiopulmonary arrest in spinal anesthesia

Juliana Arruda Godoy Limongi; Rossana Sant'Anna de Melo Lins

http://dx.doi.org/10.1590/S0034-70942011000100012 Braz J Anesthesiol, vol.61, n1, p.115-120, 2011

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Resumo

JUSTIFICATIVA E OBJETIVOS: A raquianestesia faz parte do dia a dia de inúmeros anestesiologistas. É considerada bastante segura, embora existam algumas complicações relacionadas a essa técnica, dentre as quais a mais temida é a ocorrência de parada cardiorrespiratória (PCR). A incidência real de PCR relacionada à raquianestesia, bem como sua etiologia, ainda não estão completamente elucidadas, o que motivou a realização deste artigo. CONTEÚDO: Foram revisados artigos publicados, nos últimos vinte anos, em revistas indexadas ao Medline e em um livro-texto. O propósito desta revisão foi identificar a incidência de PCR relacionada à anestesia subaracnoidea e a etiologia desses casos. Procurou-se também identificar eventuais fatores de risco. Por fim, as estratégias de tratamento descritas na literatura foram revisadas a fim de se determinar a melhor conduta diante de um caso de PCR no curso de bloqueio espinhal. CONCLUSÕES: A incidência de PCR relacionada à raquianestesia é bastante variável, e parece ser menor quando comparada à anestesia geral. No passado, acreditava-se que a PCR era decorrente de hipoxemia, relacionada, principalmente, à sedação excessiva. Entretanto, hoje se sabe que a PCR no curso de um bloqueio subaracnoideo tem etiologia cardiocirculatória, relacionada principalmente à redução da pré-carga resultante do bloqueio simpático. Existem também outros fatores que aumentam o risco para o desenvolvimento de PCR, dentre os quais merecem relevância: alterações no posicionamento do paciente e hipovolemia. Em relação ao tratamento, está bem sedimentado que o mais importante é que seja instituído precocemente. Além de um agente vagolítico, deve-se lançar mão precocemente de um simpaticomimético, em especial adrenalina, a fim de minimizar os danos para o paciente.

Palavras-chave

COMPLICAÇÕES, TÉCNICAS ANESTÉSICAS, Regional

Abstract

BACKGROUND AND OBJECTIVES: Spinal anesthesia is an integral part of the daily routine of countless anesthesiologists. It is considered to be a safe procedure, although some complications related to this technique, among them the most feared is cardiopulmonary arrest (cardiac arrest, CA), do exist. The real incidence of CA related to spinal anesthesia, as well as its etiology, is not known and has motivated this review article. CONTENTS: Articles published in the last twenty years in Medline indexed journals and in a textbook were reviewed. The objective of the present review was to identify the incidence of spinal block anesthesia-related CA and the etiology of those cases. We also tried to identify possible risk factors. Finally, treatment strategies described in the literature were reviewed in order to determine the best conduct when facing a case of CA during spinal anesthesia. CONCLUSIONS: The incidence of spinal anesthesia-related CA varies, and it seems to be lower when compared to that of general anesthesia. In the past, it was believed that CA was due to hypoxemia related especially to excessive sedation. However, nowadays, it is known that the etiology of CA during spinal block anesthesia is related to cardiocirculatory factors, mainly a reduction of preload resulting from sympathetic blockade. Other factors that increase the risk of developing CA also exist. Among those factors, the following should be mentioned: changes in patient positioning and hypovolemia. It is very important to institute treatment as soon as possible. Besides a vagolytic agent, early use of a sympathomimetic drug, especially adrenaline, is also recommended to minimize damage to the patient.

Keywords

Anesthesia, Spinal, Bradycardia, Heart arrest, Intraoperative Complications

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Parada cardiorrespiratória em raquianestesia

Cardiopulmonary arrest in spinal anesthesia

Juliana Arruda Godoy Limongi; Rossana Sant'Anna de Melo Lins

Resumo

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Abstract

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