Função renal após colecistectomia por laparoscopia e analgesia com tramadol e dipirona ou cetorolaco
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Data
2009-02-17
Autores
Medeiros, Tiago Pechutti [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
A cirurgia videolaparoscópica, minimamente invasiva, traz o benefício de menor trauma cirúrgico com conseqüente redução do tempo de internação, necessitando, entretanto, de analgesia pós-operatória (PO) eficaz e segura. A associação de analgésicos tem sido utilizada. O objetivo desta pesquisa clínica prospectiva foi estudar os efeitos, na função renal, da analgesia com tramadol, associado à dipirona ou ao cetorolaco de trometamina, em pacientes submetidos à anestesia inalatória balanceada para colecistectomia por laparoscopia. Realizou-se estudo em 126 pacientes submetidos à anestesia geral com sevoflurano, NzO e remifentanil, com boa hidratação (solução de Ringer lactato, 10 mL. kg-1. h-1), para colecistectomia por laparoscopia, divididos em dois grupos de 63 pacientes cada. O grupo 1 (G1) recebeu placebo por via venosa (iv) no momento da administração da medicação pré-anestésica (MPA), com midazolam, e tramadol 100mg e dipirona 2g, iv, antes do término da cirurgia; o grupo 2 (G2) recebeu tramado I 100mg e cetoro·laco 30mg, iv, antes do término da cirurgia, já tendo recebido 30mg de cetorolaco, iv, no momento da MPA. Foram coletadas amostras de sangue e urina pré- e pós-operatórias (PO) para determinação e comparação da estimativa do ritmo de filtração glomerular (RFG) entre os momentos e os grupos. Os RFGs foram obtidos por meio de três fórmulas, duas dependentes de valores da creatinina (Cr) e uma dependente de valores da cistatina C. Foram estudados, na urina, as enzimas tubulares fosfatase alcalina (FA) e y-glutamiltransferase (y-GT), e o seu produto, sempre indexados aos valores de Cr urinária. Na SRPA, os pacientes foram avaliados quanto à dor, ao nível de consciência, à depressão respiratória e à necessidade de analgesia de resgate com morfina. Houve hemodiluição no PO, o que dificultou a análise do perfil dos RFGs -...
The minimally invasive videolaparoscopic surgery brings the benefit of producing minimum surgical trauma with consequent reduction of hospital stay, needing, however, effective and safe post-operative (PO) analgesia. The association with analgesic has been used. This prospective clinical research aimed at studying the effects of analgesia with tramadol in the renal function, associated with dipyrone or ketorolac tromethamine, in patients submitted to inhalant balanced anesthesia for cholecistectomy through laparoscopy. A study was conducted in 126 patients submitted to general anesthesia with sevoflurane, NzO and remifentanil, with good hydration (Lactated Ringer's solution, 10mL.kg-1.h-1), for videolaparoscopic cholecistectomy, divided into 2 groups of 63 patients each. Group 1 (G1) received intravenous (iv) placebo at the moment of preanesthetic medication (PAM), with midazolam, and tramadol 100mg and dipyrone 2g, iv, before the end of the surgery; group 2 (G2) received tramadol 100mg and ketorolac 30mg, iv, before the end of the surgery, having already received 30mg of ketorolac, iv, at the moment of PAM. Preand PO blood and urine samples were collected for determination and comparison of estimated glomerular filtration rate (GFR) between the moments and groups. The GFRs were obtained via three formulas, two dependants of creatinine (Cr) values and one dependant of the cystatin C values. It was studied, in the urine, the tubular enzymes alkaline phosphatase (AP) and y-glutamiltransferase (Y-GT), and its product, always indexed to the urinary Cr values. At the recovery room (RR), patients wereevaluated in the following - pain, consciousness levels, respiratory depression and necessity of rescue analgesia with morphine. There has been hemodilution in the PO, which made more difficult the analysis of the GFRs' profile - those dependant of Cr increased and ....(Complete abstract click electronic access below)
The minimally invasive videolaparoscopic surgery brings the benefit of producing minimum surgical trauma with consequent reduction of hospital stay, needing, however, effective and safe post-operative (PO) analgesia. The association with analgesic has been used. This prospective clinical research aimed at studying the effects of analgesia with tramadol in the renal function, associated with dipyrone or ketorolac tromethamine, in patients submitted to inhalant balanced anesthesia for cholecistectomy through laparoscopy. A study was conducted in 126 patients submitted to general anesthesia with sevoflurane, NzO and remifentanil, with good hydration (Lactated Ringer's solution, 10mL.kg-1.h-1), for videolaparoscopic cholecistectomy, divided into 2 groups of 63 patients each. Group 1 (G1) received intravenous (iv) placebo at the moment of preanesthetic medication (PAM), with midazolam, and tramadol 100mg and dipyrone 2g, iv, before the end of the surgery; group 2 (G2) received tramadol 100mg and ketorolac 30mg, iv, before the end of the surgery, having already received 30mg of ketorolac, iv, at the moment of PAM. Preand PO blood and urine samples were collected for determination and comparison of estimated glomerular filtration rate (GFR) between the moments and groups. The GFRs were obtained via three formulas, two dependants of creatinine (Cr) values and one dependant of the cystatin C values. It was studied, in the urine, the tubular enzymes alkaline phosphatase (AP) and y-glutamiltransferase (Y-GT), and its product, always indexed to the urinary Cr values. At the recovery room (RR), patients wereevaluated in the following - pain, consciousness levels, respiratory depression and necessity of rescue analgesia with morphine. There has been hemodilution in the PO, which made more difficult the analysis of the GFRs' profile - those dependant of Cr increased and ....(Complete abstract click electronic access below)
Descrição
Palavras-chave
Analgesia, Opiódes, Rins, Função Renal, Renal function
Como citar
MEDEIROS, Tiago Pechutti. Função renal após colecistectomia por laparoscopia e analgesia com tramadol e dipirona ou cetorolaco. 2009. 78 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2009.