Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942011000400003
Brazilian Journal of Anesthesiology
Scientific Article

Efeitos da infusão contínua profilática de fenilefrina sobre a estratégia de redução da massa de anestésico local em pacientes submetidas à raquianestesia para cesariana

Effects of prophylactic continuous infusion of phenylephrine on reducing the mass of local anesthetic in patients undergoing spinal anesthesia for cesarean section

Vinícius Pereira de Souza; José Luiz Gomes do Amaral; Maria Ângela Tardelli; Américo Massafuni Yamashita

http://dx.doi.org/10.1590/S0034-70942011000400003 Braz J Anesthesiol, vol.61, n4, p.416-424, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: A redução da massa de anestésico local minimiza os efeitos da hipotensão arterial pós-raquianestesia para cesariana e a incidência de eventos adversos maternos preservando o bem-estar fetal, mas pode resultar em anestesia insuficiente. A hipotensão associada às maiores massas de anestésico subaracnóideo pode ser controlada com infusão contínua profilática de fenilefrina. Foram avaliados os efeitos da infusão contínua profilática de fenilefrina para controle pressórico sobre os resultados maternos e conceptuais em cesarianas com diferentes doses de bupivacaína hiperbárica na raquianestesia. MÉTODO: Realizou-se ensaio clínico prospectivo, não aleatório, com 60 gestantes a termo admitidas para cesariana eletiva. Alocaram-se as pacientes em dois grupos, na dependência da dose de bupivacaína hiperbárica administrada na raquianestesia, 12 ou 8 mg, acrescida de 5 µg de sufentanil e 100 µg de morfina. Realizou-se hidratação com 10 mL.kg-1 de solução lactato de Ringer antes do bloqueio. Logo após, iniciou-se infusão contínua de 100 µg.min-1 de fenilefrina, mantendo a pressão arterial nos valores basais. Avaliaram-se: nível de bloqueio anestésico, o consumo de vasopressores, incidência de eventos adversos maternos e condições do recém-nascido. RESULTADOS: Os dados maternos foram semelhantes entre os grupos quanto a: nível de bloqueio anestésico, consumo de fenilefrina por tempo, incidências de hipotensão, hipertensão, bradicardia, náuseas, vômitos, dispneia, dor e tremores. Os dados conceptuais evidenciaram semelhança entre os grupos quanto à gasometria e à dosagem de lactato nos vasos umbilicais. Todos os recém-nascidos apresentaram pH > 7,2. CONCLUSÕES: Mantendo-se a pressão arterial com infusão profilática contínua de fenilefrina, a incidência de eventos adversos maternos e as condições de nascimento conceptuais não diferem quando a raquianestesia é realizada com 12 mg ou 8 mg de bupivacaína hiperbárica.

Palavras-chave

ANESTESIA, ANESTÉSICOS, ANESTÉSICOS, CIRURGIA, COMPLICAÇÕES, DROGAS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVE: Reducing the mass of local anesthetic minimizes the effects of hypotension after spinal anesthesia for cesarean section and the incidence of maternal adverse events preserving fetal well-being, but it may result in insufficient anesthesia. Hypotension associated with greater masses of subarachnoid anesthesia can be controlled by prophylactic continuous infusion of phenylephrine. The effects of prophylactic continuous infusion of phenylephrine on pressure control on maternal and fetus results in cesarean sections with different doses of hyperbaric bupivacaine in spinal anesthesia. METHODS: A non-randomized prospective study of 60 gravidas at term scheduled for elective cesarean sections was undertaken. Patients were allocated into two groups depending on hyperbaric bupivacaine dose administered for spinal anesthesia, 12 or 8 mg, along with 5 µg of sufentanil and 100 µg of morphine. Patients were hydrated with 10 mL.kg-1 of Ringer's lactate before the anesthesia. Shortly after, continuous infusion of 100 µg.min-1 of phenylephrine was initiated to maintain blood pressure at baseline levels. The following parameters were evaluated: level of anesthetic blockade, consumption of vasopressors, incidence of maternal events, and conditions of the newborn. RESULTS: Maternal data was similar in both groups regarding the level of anesthetic blockade, phenylephrine consumption along time, incidence of hypotension, hypertension, bradycardia, nausea, vomiting, dyspnea, pain, and tremors. Conceptual data showed similarities between both groups regarding blood gases and umbilical vein lactate levels. The pH of all newborns was > 7.2. CONCLUSIONS: On maintaining the blood pressure with prophylactic continuous infusion of phenylephrine the incidence of maternal adverse events and conditions of birth do not differ whether spinal anesthesia is performed with 12 mg or 8 mg of hyperbaric bupivacaine.

Keywords

Phenylephrine, Anesthesia, Cesarean Section, Hypotension, Bupivacaine

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