Análise da função renal pós-operatória em cirurgia cardíaca com circulação extracorpórea em pacientes submetidos à anestesia inalatória com sevoflurano utilizando baixo fluxo de gases frescos
Carregando...
Data
2019-12-18
Autores
Lineburger, Eric Benedet
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Reduzir o fluxo de gases frescos (FGF) para menos de 1 L.min-1 durante a anestesia resulta no aquecimento e umidificação dos gases inalados, redução de custos e menor exposição ocupacional. O Composto A é formado pelo sevoflurano quando reage com absorvedores de dióxido de carbono contendo bases fortes em FGF mínimo, sendo nefrotóxico em animais. Até o momento, nenhum dado conclusivo mostrou aumento do risco em seres humanos para anestesia com sevoflurano em FGF mínimo. Objetivos: avaliar a função renal pós-operatória de pacientes submetidos a cirurgia cardíaca com circulação extracorpórea (CEC), quando anestesiados com sevoflurano FGF de 0,5 mL.min-1, em comparação ao FGF de 2 L.min-1. Método: duzentos e quatro pacientes adultos de ambos os sexos agendados para cirurgia cardíaca com CEC anestesiados com sevoflurano foram randomizados em dois grupos diferenciados pelo FGF: FGF mínimo (0,5 L.min-1) ou FGF alto (2,0 L.min-1). A medida da creatinina basal pré-operatória foi comparada diariamente aos valores obtidos nos primeiros cinco dias de pós-operatório, e o débito urinário de 24 horas foi monitorado, de acordo com os guidelines KDIGO para definir lesão renal aguda (LRA). As medidas da creatinina sérica também foram obtidas 20 e 120 dias após a alta hospitalar. Resultados: A análise por protocolo envolveu 88 e 92 pacientes no grupo FGF mínimo e FGF alto, respectivamente. A LRA pós-operatória ocorreu em 55 pacientes, 26 pacientes (29,5%) no grupo FGF mínimo e 29 pacientes (31,5%) no grupo FGF alto (P = 0,774). Pacientes com LRA tiveram uma prevalência maior de diabetes mellitus (P = 0,017) e maiores valores de creatinina basal pré-operatória (P = 0,049). Vinte dias após a alta hospitalar, 11 pacientes (6,1%) ainda permaneciam com LRA e 120 dias após a alta hospitalar, apenas 2 pacientes (1,6%). Conclusão: Concluímos que a anestesia com sevoflurano em FGF mínimo (0,5 L.min-1) durante cirurgia cardíaca com circulação extracorpórea não está associada com LRA pós-operatória, sendo esta técnica não-inferior ao FGF alto com sevoflurano.
Introduction: Reducing fresh gas flow (FGF) to less than 1 L.min-1 during anesthesia results in warming and humidification of inhaled gases, cost reduction and less occupational exposure. Compound A is generated by sevoflurane when it reacts with carbon dioxide absorbers with strong bases at minimal FGF and is nephrotoxic in animals. To date, no conclusive data has shown increased risk for minimal FGF sevoflurane anesthesia in humans. Objectives: To evaluate the postoperative renal function of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) when anesthetized with sevoflurane at 0.5 mL.min-1 FGF compared to 2 L.min-1 FGF. Method: Two hundred and four adult patients of both sexes scheduled for on-pump cardiac surgery under sevoflurane anesthesia were randomly allocated to two groups differentiated by FGF: minimal FGF anesthesia (0.5 L.min-1) or high FGF anesthesia (2.0 L.min-1). Baseline creatinine measured before surgery was compared daily to values assayed on the first five postoperative days, and 24-hour urinary output was monitored, according to the KDIGO guideline to define acute kidney injury (AKI). Creatinine measurements were also obtained 20 and 120 days after hospital discharge. Results: Per protocol analyses involved 88 and 92 patients in the minimal and high FGF groups, respectively. Postoperative AKI occurred in 55 patients, 26 patients (29.5%) in the minimal FGF group and 29 patients (31.5%) in the high FGF group (P = 0.774). Patients with AKI had greater prevalence of diabetes mellitus (P = 0.017) and higher preoperative creatinine values (P = 0.049). Twenty days after hospital discharge, 11 patients (6.1%) still had AKI and 120 days after discharge only 2 patients (1.6%) still had AKI. Conclusions: We conclude that minimal FGF (0.5 L.min-1) sevoflurane anesthesia during on-pump cardiac surgery is not associated with postoperative AKI, being this technique non-inferior to high FGF anesthesia with sevoflurane.
Introduction: Reducing fresh gas flow (FGF) to less than 1 L.min-1 during anesthesia results in warming and humidification of inhaled gases, cost reduction and less occupational exposure. Compound A is generated by sevoflurane when it reacts with carbon dioxide absorbers with strong bases at minimal FGF and is nephrotoxic in animals. To date, no conclusive data has shown increased risk for minimal FGF sevoflurane anesthesia in humans. Objectives: To evaluate the postoperative renal function of patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) when anesthetized with sevoflurane at 0.5 mL.min-1 FGF compared to 2 L.min-1 FGF. Method: Two hundred and four adult patients of both sexes scheduled for on-pump cardiac surgery under sevoflurane anesthesia were randomly allocated to two groups differentiated by FGF: minimal FGF anesthesia (0.5 L.min-1) or high FGF anesthesia (2.0 L.min-1). Baseline creatinine measured before surgery was compared daily to values assayed on the first five postoperative days, and 24-hour urinary output was monitored, according to the KDIGO guideline to define acute kidney injury (AKI). Creatinine measurements were also obtained 20 and 120 days after hospital discharge. Results: Per protocol analyses involved 88 and 92 patients in the minimal and high FGF groups, respectively. Postoperative AKI occurred in 55 patients, 26 patients (29.5%) in the minimal FGF group and 29 patients (31.5%) in the high FGF group (P = 0.774). Patients with AKI had greater prevalence of diabetes mellitus (P = 0.017) and higher preoperative creatinine values (P = 0.049). Twenty days after hospital discharge, 11 patients (6.1%) still had AKI and 120 days after discharge only 2 patients (1.6%) still had AKI. Conclusions: We conclude that minimal FGF (0.5 L.min-1) sevoflurane anesthesia during on-pump cardiac surgery is not associated with postoperative AKI, being this technique non-inferior to high FGF anesthesia with sevoflurane.
Descrição
Palavras-chave
Lesão renal aguda, Anestesia por inalação, Cirurgia Cardíaca, Acute Kidney Injury, Cardiac surgery, Inhalation anesthesia