Brazilian Journal of Anesthesiology
http://www.rba.periodikos.com.br/article/doi/10.1590/S0034-70942006000200002
Brazilian Journal of Anesthesiology
Scientific Article

Uso de dexmedetomidina em pacientes obesos mórbidos submetidos a gastroplastia: estabilidade cardiovascular e consumo de anestésicos venosos. Estudo retrospectivo

Dexmedetomidine in morbid obese patients undergoing gastroplasty: cardiovascular stability and consumption of intravenous anesthetics. A retrospective study

Luiz Piccinini Filho; Lígia Andrade da Silva Telles Mathias; Carlos Alberto Malheiros; Waldemar Montoya de Gregori; Álvaro Antonio Guaratini; Joaquim Edson Vieira

http://dx.doi.org/10.1590/S0034-70942006000200002 Braz J Anesthesiol, vol.56, n2, p.109-118, 2006
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Resumo

JUSTIFICATIVA E OBJETIVOS: A utilização de agentes anestésicos potentes e de curta duração é fundamental em pacientes submetidos à intervenção cirúrgica bariátrica. A dexmedetomidina, agonista alfa 2-adrenérgico, surgiu como uma opção adjuvante da técnica de anestesia venosa. O objetivo desta pesquisa foi avaliar a eficácia da dexmedetomidina associada à anestesia venosa, em pacientes obesos mórbidos, submetidos a gastroplastia. MÉTODO: Análise retrospectiva, de pacientes portadores de obesidade mórbida, submetidos à intervenção cirúrgica bariátrica aberta, sob anestesia com propofol e alfentanil acrescidos ou não de dexmedetomidina. Os pacientes foram alocados em dois grupos: Controle (propofol e alfentanil) e Dexmedetomidina (propofol, alfentanil e dexmedetomidina). A manutenção da anestesia nos dois grupos constou de propofol = 0,075 a 0,1 mg.kg-1.min-1 e alfentanil = 0,75 a 1 µg.kg-1.min-1; no grupo Dexmedetomidina na dose inicial de 1 µg.kg-1 em 10 min e manutenção com 0,4 a 0,7 µg.kg-1.h-1. As variáveis estudadas foram idade, sexo, IMC, tempos cirúrgico e de despertar, freqüência cardíaca (FC), pressão arterial sistólica e diastólica (PAS, PAD), saturação periférica de hemoglobina (SpO2), consumo de propofol e alfentanil e efeitos colaterais. RESULTADOS: Houve redução significativa do consumo de propofol e alfentanil no grupo Dexmedetomidina. A FC apresentou variação significativa apenas no grupo Dexmedetomidina. A PAS e a PAD apresentaram redução estatística significativa nos dois grupos nos primeiros 20 min, estabilizando-se a seguir. Os pacientes dos dois grupos não apresentaram efeitos colaterais. CONCLUSÕES: Este estudo demonstrou a eficácia do uso da dexmedetomidina associada à anestesia venosa com propofol e alfentanil, promovendo redução do consumo dos anestésicos venosos, estabilidade cardiovascular e tempo de despertar similar à técnica sem adição de dexmedetomidina. Não houve efeitos colaterais imputáveis ao uso da dexmedetomidina.

Palavras-chave

ANALGÉSICOS, Opióides, ANESTESIA, Geral, ANESTÉSICOS, Venoso, CIRURGIA, Abdominal, DOENÇAS, DROGAS

Abstract

BACKGROUND AND OBJECTIVES: The administration of powerful and short duration anesthetic agents is essential for patients undergoing bariatric surgical procedure. The dexmedetomidine, an alpha 2-adrenergic agonist, has appeared as an adjuvant option of the venous anesthesia technique. This study aimed at assessing the efficacy of dexmedetomidine associated with the venous anesthesia in morbid obese patients undergoing gastroplasty procedures. METHODS: Retrospective analysis of morbid obese patients undergone open bariatric surgical intervention under anesthesia with propofol and alfentanil, with or without dexmedetomidine. Patients were allocated into two groups: Control (propofol and alfentanil) and Dexmedetomidine (propofol, alfentanil and dexmedetomidine). For both groups, the anesthetic maintenance was as follows: propofol = 0.075 to 0.1 mg.kg-1.min-1 and alfentanil = 0.75 to 1 µg.kg-1.min-1; in the dexmedetomidine (DMD) group, initial dose of 1 µg.kg-1 in 10 min and maintenance with 0.4 to 0.7 µg.kg-1.h-1. The variables studied were: age, gender, body mass index (BMI), surgical time and recovery time, heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), hemoglobin peripheral saturation (SpO-2), propofol and alfentanil consumption and side effects. RESULTS: The dexmedetomidine group has shown a significant reduction in propofol and alfentanil consumption. The heart rate presented a significant variation only in the dexmedetomidine group. Both SPB and DBP presented a statistically significant reduction in both groups for the first 20 minutes, and subsequent stabilization. No side effects were observed in both groups of patients. CONCLUSIONS: This study has shown the efficacy of dexmedetomidine administration in combination with venous anesthesia with propofol and alfentanil, thus promoting reduction in venous anesthetic drugs consumption, cardiovascular stability and time to recovery similar to that of the technique without dexmedetomidine. No side effects were noted associated with the use of dexmedetomidine.

Keywords

ANALGESICS, Opioids, ANESTHESIA, General, ANESTHETICS, Venous, DISEASES, DRUGS, SURGERY, Abdominal

References

Abir F, Bell R. Asssessment and management of the obese patient. Crit Care Med. 2004;32:S87-S91.

Reves JG, Glass PSA, Lubarsky DA. Intravenous nonopioid anesthetics. Miller's Anesthesia. 2005:317-378.

Talke P, Li J, Jain U J. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. Anesthesiology. 1995;82:620-633.

Segal IS, Vickery RG, Walton JK. Dexmedetomidine diminishes halothane anesthetics requirements in rats through a postsynaptic alpha a adrenergic receptor. Anesthesiology. 1988;69:818-823.

Doze VA, Chen BX, Maze M. Dexmedetomidine produces a hypnotic-anesthetic action in rats via activation of central alpha-2-adrenoceptors. Anesthesiology. 1989;71:75-79.

Matevosian R, Nourmand H. Monitoring. Adult perioperative Anesthesia. 2004:102-136.

Torres MLA, Cicarelli DD, Lanza M. Monitorização. Anestesiologia: Princípios e Técnicas. 2004:420-455.

Malheiros CA, Rodrigues FCM. Quando indicar cirurgia para obesidade mórbida?. Rev Ass Med Bras. 2000;46:303.

Putnam L, Jenicek JA, Allen CR. Anesthesia in the morbidlyobese patient. South Med J. 1974;67:1411-1417.

Gelman S, Laws HL, Potzick J. Thoracic epidural vs balanced anesthesia in morbid obesity: an intraoperative and postoperative hemodynamic study. Anesth Analg. 1980;59:902-908.

Servin F, Farinotti R, Haberer JP. Propofol infusion for maintenance of anesthesia in morbidly obese patients receiving nitrous oxide: A clinical and pharmacokinetic study. Anesthesiology. 1993;78:657-665.

Salihoglu Z, Demiroluk S, Demirkiran KY. Comparison of effects of remifentanil, alfentanil and fentanil on cardiovascular responses to tracheal intubation in morbidlyobese patients. Eur J Anaesthesiol. 2002;19:125-128.

Salihoglu Z, Karaca S, Kose Y. Total intravenous anesthesia versus single breath technique and anesthesia maintenance with sevoflurane for bariatric operations. Obes Surg. 2001;11:496-501.

Hofer RE, Sprung J, Sarr MG. Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics. Can J Anesth. 2005;52:176-180.

Ramsay MA, Jones CCRN, Cancemi MR. Dexmedetomidine improves postoperative pain management in bariatric surgical patients. ASA Annual Meeting Abstracts. 2002;97:A910.

Walker G, Donahue B, Costabile S. Dexmedetomidine in bariatric surgery patients. ASA Annual Meeting Abstracts. 2003;99:A50.

Cheymol G. Effects of obesity on pharmacokinetics. Clin Pharmacokinet. 2000;39:215-31.

De Baerdemaeker LEC, Mortier EP, Struys MMRF. Pharmacokinetics in obese patients. Cont Educ Anesth, Crit Care Pain. 2004;4:152-155.

Bouillon T, Shafer SL. Does size matter?. Anesthesiology. 1998;89:557-560.

Stoelting RK, Dierdorf SF. Nutritional Diseases and Inborn Errors of Metabolism. Anesthesia and Co-Existing Disease. 2002:441-470.

Bardoczky G, Yernault JC, Houben JJ. Large tidal volume ventilation does not improve oxygenation in morbidly obese patients during anesthesia. Anesth Analg. 1995;81:385-388.

Pelosi P, Croci M, Ravagnan I. Respiratory system mechanics in sedated, paralyzed, morbidly obese patients. J Appl Physiol. 1997;82:811-818.

Pelosi P, Croci M, Ravagnan I. The effects of body mass on lung volumes, respiratory mechanics, and gás exchange during general anesthesia. Anesth Analg. 1998;87:654-660.

Auler JO Jr, Miyoshi E, Fernandes CR. The effects of abdominal opening on respiratory mechanics during general anesthesia in normal and morbidly obese patients: a comparative study. Anesth Analg. 2002;94:741-748.

Frappier J, Guenoun T, Journois D. Airway management using the intubating laryngeal mask airway for the morbidly obese patients. Anesth Analg. 2003;96:1510-1515.

Coussa M, Proietti S, Schnyder P. Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients. Anesth Analg. 2004;98:1491-1495.

Gaszynski TM, Strzelczyk JM, Gaszynski WP. Post-anesthesia recovery after infusion of propofol with remifentanil or alfentanil or fentanyl in morbidly obese patients. Obes Surg. 2004;14:498-503.

Gander S, Frascarolo P, Suter M. Positive end-expiratory pressure during induction of general anesthesia increases of nonhypoxic apnea in morbidlyobese patients. Anesth Analg. 2005;100:580-584.

Aantaa RE, Kanto J, Scheinin M. Dexmedetomidine, an alpha2-adrenoceptor agonist, reduces anesthetic requirements for patients undergoing minor gynecologic surgery. Anesthesiology. 1990;73:230-235.

Aantaa R, Jaakola ML, Kallio A. Reduction of the minimum aveolar concetration of isoflurane by dexmedetomidine. Anesthesiology. 1997;86:1055-1060.

Jaakola ML, Ali-Melkkilä T, Kanto J. Dexmedetomidine reduces intraocular pressure, intubation responses, and anesthetic requirements in patients undergoing ophthalmic surgery. Brit J Anaesth. 1992;68:570-575.

Bührer M, Mappes A, Lauber R. Dexmedetomidine decreases thiopental dose requirement and alters distribution pharmacokinetics. Anesthesiology. 1994;80:1216-1227.

Jalonen J, Hynynen M, Kuitunen A. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology. 1997;86:331-345.

Wyngaarden JB, Smith LH, Bennett JC. Cardiovascular Disease. Cecil Texbook of Medicine. 1992:355-367.

Wright RA, Decroly P, Kharkevitch T. Exercise tolerance in angina is improved by mivazerol - an alpha2-adrenoceptor agonist. Cardiovasc Drugs Ther. 1993;7:929-934.

Hunter JD, Reid C, Noble D. Anaesthetic management of the morbidly obese patient. Hosp Med. 1998;59:481-483.

Ogunnaike BO, Whitten CW. Anesthetic management of morbidlyobese patients. Semin Anesth Periop Med Pain. 2002;21:46-58.

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