Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000300002
Brazilian Journal of Anesthesiology
Scientific Article

Interferência da circulação extracorpórea no despertar da anestesia de pacientes submetidos à revascularização do miocárdio

Extracorporeal circulation interference on emergence from anesthesia in patients submitted to myocardial revascularization

Ricardo Antonio Guimarães Barbosa; Luiz Marcelo Sá Malbouisson; Luciana Moraes dos Santos; Marilde de Albuquerque Piccioni; Maria José Carvalho Carmona

http://dx.doi.org/10.1590/S0034-70942012000300002 Braz J Anesthesiol, vol.62, n3, p.293-297, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: A circulação extracorpórea (CEC) pode alterar a farmacocinética dos fármacos, assim como a função cerebral. Os objetivos deste estudo foram comparar o tempo de despertar e a intensidade da sedação pós-operatória avaliada pelo índice bispectral (BIS) e pela escala de sedação de Ramsay, em pacientes submetidos à revascularização miocárdica (RM) com ou sem CEC. MÉTODO: Dez pacientes submetidos à RM com CEC (Grupo CEC) e 10 sem CEC (Grupo sem CEC) foram anestesiados com sufentanil, infusão alvo-controlada de propofol 2,0 µg.mL-1 e pancuronio. Após a cirurgia diminuiu-se a infusão de propofol para 1 µg.mL-1 que foi suspensa quando da indicação da extubação. Foram avaliados o BIS, a escala de Ramsay e o tempo de despertar dos pacientes. RESULTADOS: O grupo CEC apresentou valores menores de BIS desde 60 minutos após a cirurgia (sem CEC = 66 ± 13 e CEC = 53 ± 14, p = 0,01) até 120 minutos após a infusão (sem CEC = 85 ± 8 e CEC = 73 ± 12, p = 0,02). O nível de sedação pela escala de Ramsay foi maior no grupo CEC nos momentos 30 minutos após o final da cirurgia (sem CEC = 5 ± 1 e CEC = 6 ± 0, p = 0,021), no final da infusão (sem CEC = 5 ± 1 e CEC = 6 ± 1, p = 0,012) e 5 minutos após o final da infusão (sem CEC = 4 ± 1 e CEC = 5 ± 0,42, p = 0,039). O tempo de despertar foi maior no grupo CEC (sem CEC = 217 ± 81 e CEC = 319 ± 118, p = 0,038). CONCLUSÕES: Houve maior intensidade da sedação após o final da cirurgia e o maior tempo de despertar no grupo com CEC, sugerindo alteração na farmacocinética do propofol ou efeitos da CEC sobre o sistema nervoso central.

Palavras-chave

anestésicos, venoso, propofol, equipamentos, oxigenador, circulação extracorpórea, farmacologia, Farmacocinética, sedação, profunda

Abstract

BACKGROUND AND OBJECTIVES: Extracorporeal circulation (ECC) may change drug pharmacokinetics as well as brain function. The objectives of this study are to compare emergence time and postoperative sedation intensity assessed by the bispectral index (BIS) and the Ramsay sedation scale in patients undergoing myocardial revascularization (MR) with or without ECC. METHOD: Ten patients undergoing MR with ECC (ECC group) and 10 with no ECC (no-ECC group) were administered with sufentanyl, propofol 2.0 µg.mL-1 and pancuronium target controlled infusion. After surgery, propofol infusion was reduced to 1 µg.mL-1 and suspended when extubation was indicated. Patients BIS, Ramsay scale and time to wake up were assessed. RESULTS: The ECC group showed lower BIS values beginning at 60 minutes after surgery (no-ECC = 66 ± 13 and ECC = 53 ± 14, p = 0.01) until 120 minutes after infusion (no-ECC = 85 ± 8 and ECC = 73 ± 12, p = 0.02). Sedation level measured by the Ramsay scale was higher in the ECC group at 30 minutes after the end of the surgery (no-ECC = 5 ± 1 and ECC = 6 ± 0, p = 0.021), at the end of infusion (no-ECC = 5 ± 1 and ECC = 6 ± 1, p = 0.012) and 5 minutes after the end of infusion (no-ECC = 4 ± 1 and ECC = 5 ± 0.42, p = 0.039). Emergence from anesthesia time was higher in the ECC group (no-ECC = 217 ± 81 and ECC = 319 ± 118, p = 0.038). CONCLUSIONS: There was a higher intensity of sedation after the end of surgery and a longer wake up time in ECC group, suggesting changes in the pharmacokinetics of propofol or effects of ECC on central nervous system.

Keywords

deep sedation, extracorporeal circulation, pharmacokinetics, propofol

References

Barbosa RAG, Santos SRCJ, White PF. Effects of cardiopulmonary bypass on propofol pharmacokinetics and bispectral index during coronary surgery. Clinics. 2009;64:215-221.

Mets B. The pharmacokinetics of anesthetic drugs and adjuvants during cardiopulmonary bypass. Acta Anaesthesiol Scand. 2000;44:261-273.

Gouke CR, Keaveny JP, Kay B, Healy TE, Ryan M. The effect of cardiopulmonary bypass on the pharmacokinetics of drugs. Clin Pharmacokinet. 1982;7:234-251.

Buylaert WA, Herregods LL, Mortier EP, Bogaert MG. Cardiopulmonary bypass and the pharmacokinetics of drugs. . 1989;17:10-26.

Wood M. Plasma drug binding: implications for anesthesiologists. Anesth Analg. 1979;65:786-804.

Wood M. Plasma drug binding: implications for anesthesiologists. Anesth Analg. 1986;65:786-804.

Hiraoka H, Yamamoto K, Morita T, Goto F, Horiuchi R. Changes in drug plasma concentrations of an extensively bound and highly extracted drug, propofol, in reponse to altered plasma binding. Clin Pharmacol Ther. 2004;75:324-330.

Bailey JM, Mora CT, Shafer SL. Pharmacokinetics of propofol in adult patients undergoing coronary revascularization. Anesthesiology. 1996;84:1288-1297.

White PF. Intravenous anesthesia ana analgesia: what is the role of target-controlled infusion (TCI). J Clin Anesth. 1996;8:26-28.

Massey NJ, Sherry KM, Oldroyd S, Peaccock JE. Pharmacokinetics of infusion of propofol during cardiac surgery. Br J Anaesth. 1990;65:475-479.

Lee HS, Khoo YM, Chua BC, Tan SS, Chew SL. Pharmacokinetics of propofol infusion in Asian patients undergoing coronary artery bypass grafting. Ther Drug Monit. 1995;17:336-341.

Hammaren E, Yli-Hankala A, Rosenberg PH, Hynynem M. Cardiopulmonary bypass-induced changes in plasma concentrations of propofol and in auditory evoked potentials. Br J Anaesth. 1996;77:360-364.

Ramsay MA, Savege TM, Simpson BR, Goodwin R. Controlled sedation with alphaxalone-alphadolone. Br Med J. 1974;2:656-659.

Fisher DM. Development and clinical application of electroencephalographic Bispectrum monitoring. Anesthesiology. 2000;93:1336-1344.

Sigl JC, Chamoun NG. An introduction to bispectral analysis for the electroencephalogram. J Clin Monit. 1994;10:392-404.

White PF. Intravenous anesthesia and analgesia: what is the role of target-controlled infusion (TCI). J Clin Anesth. 1996;8:26-28.

Kenny GNC, Sutcliffe N. European perspective. Textbook of intravenous anesthesia. 1997:527-537.

Glass PSA, Markhan K, Ginsberg B, Hawkins ED. Propofol concentrations required for surgery. Anesthesiology. 1989;71:A273.

Yoshitani H, Takeuchi M, Sakamoto K, Akasaka T, Yoshida K, Yoshikawa J. Effect of one or more co-morbid conditions on diagnostic accuracy of coronary flow velocity reserve for detecting significant left anterior descending coronary stenosis. Heart. 2005;91:1294-1298.

Lysakowski C, Dumont L, Pellegrini M, Clergue F, Tassony E. Effects of fentanyl, alfentanil, remifentanil and sufentanil on loss of consciousness and bispectrum index during propofol induction of anaesthesia. Br J Anaesth. 2001;86:523-527.

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