Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942013000300003
Brazilian Journal of Anesthesiology
Scientific Article

Influência dos Hipnóticos no bloqueio neuromuscular produzido pelo cisatracúrio: emprego da aceleromiografia

Influence of hypnotics on cisatracurium-induced neuromuscular block: use of acceleromyograhpy

Angélica de Fátima de Assunção Braga; Franklin Sarmento da Silva Braga; Glória Maria Braga Potério; José Aristeu Fachini Frias; Fernanda Maria Silva Pedro; Derli Conceição Munhoz

http://dx.doi.org/10.1590/S0034-70942013000300003 Braz J Anesthesiol, vol.63, n3, p.249-253, 2013
PDF Português
PDF English
Downloads: 0
Views: 765

Resumo

JUSTIFICATIVA E OBJETIVOS: Os efeitos farmacodinâmicos dos bloqueadores neuromusculares (BNM) podem ser influenciados por diferentes drogas, entre elas os hipnóticos. O objetivo deste estudo foi avaliar a influência do propofol e do etomidato sobre o bloqueio neuromuscular produzido pelo cisatracúrio. MÉTODO: Foram incluídos 60 pacientes, ASA I e II, submetidos a cirurgias eletivas sob anestesia geral, distribuídos aleatoriamente em dois grupos de acordo com o hipnótico empregado: GI (propofol) e GII (etomidato). As pacientes receberam midazolam (0,1 mg.kg-1) por via muscular como medicação pré-anestésica, a indução foi com propofol (2,5 mg.kg-1) ou etomidato (0,3 mg.kg-1) precedido de fentanil (250 µg) e seguido de cisatracúrio (0,1 mg.kg-1). Os pacientes foram ventilados com oxigênio a 100% até a obtenção de redução de 95% ou mais na amplitude da resposta do adutor do polegar, quando foi feita a laringoscopia e a intubação traqueal. A função neuromuscular foi monitorizada com aceleromiografia. Avaliaram-se o início de ação do cisatracúrio, as condições de intubação traqueal e as repercussões hemodinâmicas. RESULTADOS: Os tempos médios e os desvios padrão para o início de ação do cisatracúrio foram: GI (86,6 ± 14,3") e GII (116,9 ± 11,6"), com diferença significativa (p < 0,0001). As condições de intubação traqueal foram aceitáveis em 100% dos pacientes do GI e em 53,3% no GII (p < 0,0001). CONCLUSÕES: A instalação do bloqueio neuromuscular com o cisatracúrio foi mais rápida e as condições de intubação traqueal foram melhores nos pacientes que receberam propofol em relação ao grupo que recebeu etomidato, sem repercussões hemodinâmicas.

Palavras-chave

HIPNÓTICOS, Propofol, etomidato, BLOQUEADOR MUSCULAR, Cisatracúrio, TÉCNICAS DE MEDIÇÃO, Aceleromiografia

Abstract

BACKGROUND AND OBJECTIVE: Different drugs, including hypnotics, may influence the pharmacodynamic effects of neuromuscular blockers (NMB). The aim of this study was to evaluate the influence of propofol and etomidate on cisatracurium-induced neuromuscular blockade. METHOD: We included 60 patients, ASA I and II, undergoing elective surgery under general anesthesia in the study and randomly allocated them into two groups, according to their hypnotic drug: GI (propofol) and GII (etomidate). Patients received intramuscular (IM) midazolam (0.1 mg.kg-1) as premedication and we performed induction with propofol (2.5 mg.kg-1) or etomidate (0.3 mg.kg-1), preceded by fentanyl (250 mg) and followed by cisatracurium (0.1 mg.kg-1). The patients were ventilated with 100% oxygen until obtaining a reduction of 95% or more in the adductor pollicis response amplitude, with subsequent laryngoscopy and tracheal intubation. Neuromuscular function was monitored by acceleromyograhpy. We evaluated the onset of action of cisatracurium, tracheal intubation conditions, and hemodynamic repercussions. RESULTS: The mean time and standard deviations of cisatracurium onset were: GI (86.6 ± 14.3 s) and GII (116.9 ± 11.6 s), with a significant difference (p < 0, 0001). Intubation conditions were acceptable in 100% of GI and 53.3% of GII patients (p < 0.0001). CONCLUSION: Induction of neuromuscular blockade with cisatracurium was faster, with better intubation conditions in patients receiving propofol compared to those receiving etomidate, without hemodynamic repercussions.

Keywords

Hypnotics and Sedatives, Propofol, Etomidate, Neuromuscular blockade, Monitoring, Physiologic

References

Fuchs-Buder T, Claudius C, Skovgaard LT. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiol Scand. 2007;51:789-808.

Viby-Mogensen J, Engbaek J, Eriksson LI. Good clinical research practice (GCRP) in pharmacodynamic studies of neuromuscular blocking agents. Acta Anaesthesiol Scand. 1996;40:59-74.

Viby-Mogensen J, Ostergaard D, Donati F. Pharmacokinetic studies of neuromuscular blocking agents: good clinical research practice (GCRP). Acta Anaesthesiol Scand. 2000;44:1169-1190.

Muir AW, Anderson KA, POW E. Interaction between rocuronium bromide and some drugs, used during anaesthesia. Eur J Anaesthesiol. 1994;11(^s9):93-98.

Gill RS, Scott RPF. Etomidate short the onset time of neuromuscular block. Br J Anaesth. 1992;69:444-446.

Dilger JP, Liu Y, Vidal AM. Interactions of general anaesthetics with single acetylcholine receptor channels. Eur J Anaesthesiol. 1995;12:31-39.

Abdel-Zaher AO, Askar FG. The myoneural effects of propofol emulsion (Diprivan) on the nerve-muscle preparations of rats. Pharmacol Res. 1997;36(4):323-332.

Braga AFA, Braga FSB, Potério GMB. The effect of different doses of propofol on tracheal intubating conditions without muscle relaxant in children. Eur J Anaesthesiol. 2001;18:384-388.

Savarese JJ, Lien CA, Belmont MR. The clinical pharmacology of new benzylisoquinoline-diester compounds, with special consideration of cisatracurium and mivacurium. Anaesthesist. 1997;46:840-849.

Munhoz DC, Braga AFA, Potério GMB. Influência do propofol e do etomidato no bloqueio neuromuscular produzido pelo rocurônio: Avaliação pela aceleromiografia. Rev Bras Anestesiol. 2002;52:673-680.

Bluestein LS, Stinson LW Jr, Lennon RL. Evaluation of cisatracurium, a new neuromuscular blocking agent, for tracheal intubation. Can J Anaesth. 1996;43:925-931.

Kirov K, Motamed C, Decailliot F. Comparison of the neuromuscular blocking effect of cisatracurium and atracurium on the larynx and adductor pollicis. Acta Anaesthesiol Scand. 2004;48:577-581.

Taha SK, Siddik-Sayyid SM, Alameddine M. Propofol is superior to thiopental for intubation without muscle relaxants. Can J Anaesth. 2005;52:249-253.

Erhan E, Ugur G, Gunusen I. Propofol: not thiopental or etomidate - with remifentanil provides adequate intubating conditions in the absence of neuromuscular blockade. Can J Anaesth. 2003;50:108-115.

Barker P, Langton JA, Wilson IG. Movements of the vocal cords on induction of anaesthesia with thiopentone or propofol. Br J Anaesth. 1992;69:23-25.

Brown GW, Patel Ellis FR. Comparison of propofol and thiopentone for laryngeal mask insertion. Anaesthesia. 1991;46:771-772.

Kallar MD. Propofol allows intubation without relaxants. Anesthesiology. 1990;73.

Woods AW, Allam S. Tracheal intubation without the use neuromuscular blocking agents. Br J Anaesth. 2005;94:151-158.

Sneyd R, O' Sullivan E. Tracheal intubation without neuromuscular blocking agents: is there any point?. Br J Anaesth. 2010;104:535-537.

Siddik-Sayyid SM, Taha SK, Aouad MT. Propofol 2m/kg is superior to propofol 2mg/kg for tracheal intubation in children during sevoflurane induction. Acta Anaesthesiol Scand. 2011;55:535-538.

De Mey JC, De Baerdemaeker L, De Laat M. The onset of neuromuscular block at the masseter muscle as a predictor of optimal intubating conditions with rocuronium. Eur J Anaesthesiol. 1999;16:387-389.

Braga Ade F, Munoz DC, Braga FS. Influence of stimulus frequency on blockade induced by pancuronium and rocuronium: study on rats phrenic nerve-diaphragm preparation. Acta Cir Bras. 2007;22:446-450.

Curran MJ, Donati F, Bevan DR. Onset and recovery of atracurium and suxamethonium: induced neuromuscular blockade with simultaneous train-of-four and single twitch stimulation. Br J Anaesth. 1987;59:989-994.

Girling KJ, Mahajan RP. The effect of stabilization on the onset of neuromuscular block when assessed using accelerometry. Anesth Analg. 1996;82:1257-1260.

McCoy EP, Mirakhur RK, Maddineni VR. Pharmacokinetics of rocuronium after bolus and continuous infusion during halothane anaesthesia. Br J Anaesth. 1995;76:29-33.

Saxena PR, Dhasmana KM, Prakash O. A comparison of systemic and regional haemodynamic effects of d-tubocurarine, pancuronium. and vecuronium. Anesthesiology. 1983;59:102-108.

Scott RPF, Savarese JJ, Basta SJ. Clinical pharmacology of atracurium given high dose. Br J Anaesth. 1986;58:834-838.

Tullock WC, Diana P, Cook DR. Neuromuscular and cardiovascular effects of high-dose vecuronium. Anesth Analg. 1990;70:86-90.

Aun CST, Sung RYT, O'Meara ME. Cardiovascular effects of intravenous induction in children: comparison between propofol and thiopentone. Br J Anaesth. 1993;70:647-653.

5dd422640e8825a50ac63494 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