Uso de anestésicos halogenados na circulação extracorpórea

Caetano Nigro Neto; Maria Angela Tardelli; Paulo Henrique Dagola Paulista

doi:10.1590/S0034-70942012000300007

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Uso de anestésicos halogenados na circulação extracorpórea

Use of volatile anesthetics in extracorporeal circulation

Caetano Nigro Neto; Maria Angela Tardelli; Paulo Henrique Dagola Paulista

http://dx.doi.org/10.1590/S0034-70942012000300007 Braz J Anesthesiol, vol.62, n3, p.350-355, 2012

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Resumo

JUSTIFICATIVA E OBJETIVOS: O uso dos anestésicos inalatórios em cirurgia cardíaca não é recente. Desde a introdução do halotano na prática clínica, vários centros de cirurgia cardíaca passaram a fazer uso rotineiro destes anestésicos. CONTEÚDO: Nos últimos anos, um grande número de estudos vem demonstrando que os anestésicos inalatórios exercem um efeito protetor contra a disfunção isquêmica miocárdica. Evidências experimentais têm indicado que os halogenados apresentam efeitos cardioprotetores que não são explicados apenas por alterações de fluxo coronariano ou pelo balanço entre a oferta e o consumo de oxigênio pelo miocárdio. Aliado a este fato, o uso de anestésicos inalatórios durante a circulação extracorpórea (CEC) em cirurgia cardíaca tem um papel importante. O principal fato se deve às recentes pesquisas que confirmam as propriedades cardioprotetoras destes agentes, com melhores resultados quando se utiliza o anestésico inalatório durante todo o procedimento cirúrgico, inclusive durante a CEC. O uso destes agentes através de vaporizadores calibrados adaptados ao circuito da CEC por meio das membranas dos oxigenadores tem o seu uso cada vez mais frequente, fazendo com que os profissionais envolvidos, como anestesiologistas e perfusionistas, necessitem adquirir certos conhecimentos para elucidar possíveis dúvidas que possam surgir.

Palavras-chave

anestésicos, volátil, cirurgia, cardíaca, equipamentos, oxigenador, circulação extracorpórea

Abstract

BACKGROUND AND OBJECTIVES: The use of volatile anesthetics in cardiac surgery is not recent. Since the introduction of halothane in clinical practice, several cardiac surgery centers started to use these anesthetics constantly. CONTENT: In the last years a great number of studies haveshown that the volatile anesthetics have a protecting effect against myocardial ischemic dysfunction. Experimental evidences have shown that the halogenated anesthetics have cardioprotective effects that cannot be only explained by coronary flow alterations or by the balance between myocardium available and consumed oxygen. In addition to that, the use of volatile anesthetics during extracorporeal circulation (ECC) in cardiac surgery plays an important role. Recent studies have proven that these agents have cardioprotective properties and produce better results when the volatile anesthetic is used during the whole surgery procedure, including ECC. The use of halogenated anesthetics through calibrated vaporizers adapted to the ECC circuit via oxygenator membranes has become popular. Therefore, the professionals involved such as anesthesiologists and perfusionists should learn specifcs in order to solve possible doubts.

Keywords

anesthetics, volatile, cardiac surgical procedures, extracorporeal circulation, ischemic preconditioning, oxygenators, membrane

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Uso de anestésicos halogenados na circulação extracorpórea

Use of volatile anesthetics in extracorporeal circulation

Caetano Nigro Neto; Maria Angela Tardelli; Paulo Henrique Dagola Paulista

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Abstract

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