Dosagem de NGAL no perioperatório de cirurgia bariátrica videolaparoscópica: comparação de Anestesia Venosa Total (TIVA) versus Sevoflurano
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Data
2012-08-31
Autores
Fernandes, Adriano Teixeira [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A cirurgia bariátrica videolaparoscópica (CBVL) é “padrão ouro” para o tratamento cirúrgico de obesidade mórbida. Entretanto, o pneumoperitônio pode trazer riscos aos rins, decorrentes da sua duração e da magnitude da pressão intra-abdominal, que acarreta diminuição do fluxo sanguíneo renal, habitualmente expresso como oligúria reversível. Além disso, como outros tipos de cirurgia, a CBVL deflagra resposta inflamatória aguda. A NGAL (lipocalina associada à gelatinase dos neutrófilos) é um marcador precoce, específico e sensível de função renal, assim como um marcador da resposta inflamatória. Os anestésicos gerais, tanto o propofol quanto o sevoflurano, exercem proteção aos rins e atenuam a resposta inflamatória aguda decorrente do trauma cirúrgico. O objetivo deste estudo foi comparar a variação dos níveis séricos da NGAL e sua associação com critérios de lesão renal aguda (LRA) RIFLE no perioperatório de CBVL comparando a anestesia geral venosa total (TIVA) com propofol e a anestesia inalatória com sevoflurano (SEVO). 64 pacientes submetidos à CBVL foram randomizados para dois grupos de anestesia, TIVA e SEVO, 32 pacientes por grupo. Amostras sanguíneas para dosagem de creatinina e NGAL foram colhidas em três momentos: M0, antes da indução anestésica; M1, 6 horas após pneumoperitônio; e M2, 24 horas após o pneumoperitônio. A diurese foi mensurada por 24 horas e critério RIFLE estratificado por período. Diferenças entre as medidas foram comparadas por testes não paramétricos. Não encontramos incidência de lesão renal aguda (LRA) pelo critério RIFLE em nenhum dos grupos; diferenças na incidência de classificação de risco pelo critério RIFLE nos dois grupos; diferença estatisticamente significante nas medidas perioperatórias de NGAL sérica entre os dois tipos de anestesia em nenhum dos...
Videolaparoscopic bariatric surgery (VLBS) is the gold standard for surgical treatment of obesity. However, pneumoperitoneum may pose risks to the kidneys due to a decrease in renal blood flow usually expressed as reversible oliguria. Furthermore, as other types of surgery, VLBS triggers acute inflammatory response. Lipocalin-2 (NGAL) is an early, specific and sensitive biomarker of acute renal injury, as well as a marker of inflammatory response. General anesthetics, both propofol and sevoflurane, exert protection to the kidneys and attenuate the acute inflammatory response from surgical trauma. The objective was to compare the effects of two types of general anesthesia, total intravenous anesthesia (TIVA) versus inhalation anesthesia with sevoflurane (SEVO), on the variation of serum NGAL in the perioperative period of VLBS and its association with RIFLE criteria of acute kidney injury at the same period. Sixty-four patients scheduled for CBVL were randomized for two groups of anesthesia, TIVA or SEVO. Blood samples for creatinine and serum NGAL were collected in three moments (M0 – before anesthesia, M1 - 6 hours after pneumoperitoneum and M2 - 24 hours after pneumoperitoneum) and urine output was measured for 24hours in the post-operative period for RIFLE criteria inclusion. The RIFLE criteria was used to evaluate acute kidney injury (AKI) after 6 an 24 hours of pneumoperitoneum. Differences between groups were compared with non-parametric tests. There was no incidence of AKI by RIFLE Criteria in either group. There were no significant differences in serum NGAL during the perioperative period in both groups. There was no difference in RIFLE criteria classification in either group. Conclusion: We did not... (Complete abstract click electronic access below)
Videolaparoscopic bariatric surgery (VLBS) is the gold standard for surgical treatment of obesity. However, pneumoperitoneum may pose risks to the kidneys due to a decrease in renal blood flow usually expressed as reversible oliguria. Furthermore, as other types of surgery, VLBS triggers acute inflammatory response. Lipocalin-2 (NGAL) is an early, specific and sensitive biomarker of acute renal injury, as well as a marker of inflammatory response. General anesthetics, both propofol and sevoflurane, exert protection to the kidneys and attenuate the acute inflammatory response from surgical trauma. The objective was to compare the effects of two types of general anesthesia, total intravenous anesthesia (TIVA) versus inhalation anesthesia with sevoflurane (SEVO), on the variation of serum NGAL in the perioperative period of VLBS and its association with RIFLE criteria of acute kidney injury at the same period. Sixty-four patients scheduled for CBVL were randomized for two groups of anesthesia, TIVA or SEVO. Blood samples for creatinine and serum NGAL were collected in three moments (M0 – before anesthesia, M1 - 6 hours after pneumoperitoneum and M2 - 24 hours after pneumoperitoneum) and urine output was measured for 24hours in the post-operative period for RIFLE criteria inclusion. The RIFLE criteria was used to evaluate acute kidney injury (AKI) after 6 an 24 hours of pneumoperitoneum. Differences between groups were compared with non-parametric tests. There was no incidence of AKI by RIFLE Criteria in either group. There were no significant differences in serum NGAL during the perioperative period in both groups. There was no difference in RIFLE criteria classification in either group. Conclusion: We did not... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Cirurgia bariátrica, Laparoscopia, Rins - Doenças, Obesidade, Anestesicos - Efeito fisiologico, Obesity - Surgery
Como citar
FERNANDES, Adriano Teixeira. Dosagem de NGAL no perioperatório de cirurgia bariátrica videolaparoscópica: comparação de Anestesia Venosa Total (TIVA) versus Sevoflurano. 2012. 60 f. Dissertação (mestrado) - Universidade Estadual Paulista Julio de Mesquita Filho, Faculdade de Medicina de Botucatu, 2012.