Efeito do propofol associado à efedrina no tempo da latência do cisatracúrio
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2006-11-24
Autores
Moro, Eduardo Toshiyuki [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Justificativa e Objetivos: o início de ação dos agentes bloqueadores neuromusculares pode ser influenciado por fatores que incluem a distância do músculo ao coração, o fluxo sangüíneo muscular e o débito cardíaco. O propofol pode causar hipotensão arterial, principalmente quando associado a um opióide, o que diminuiria o fluxo sangüíneo muscular e, portanto tem sido citado como um fator responsável pelo aumento do tempo de latência dos bloqueadores neuromusculares. O objetivo deste estudo foi avaliar a eficácia da efedrina na prevenção dos efeitos hipotensores arteriais induzidos pela associação do propofol e do remifentanil, assim como os efeitos sobre o tempo de latência do cisatracúrio. Método: foram selecionados 60 pacientes com idade entre 18 e 52 anos, estado físico ASA I ou II, que seriam submetidos à cirurgia eletiva sob anestesia geral e divididos em 3 grupos, de modo aleatório. A distribuição dos pacientes foi realizada de acordo com a solução empregada durante a indução da anestesia como segue: G I (n=20) - Propofol 1 %; G II (n=20) - Propofol 1% + efedrina 0,5 mg.ml-1 e G III (n=20) - Propofol 1% + efedrina 1,0 mg.ml-1. Após a pré-oxigenação com O2 a 100% em máscara facial, foi administrado remifentanil em infusão contínua, por via venosa (0,5 mg.kg-1.min-1), por 90 segundos. Em seguida foi administrado o propofol 1% (associado ou não à efedrina), com velocidade de infusão igual a 180 ml.h-1, até a perda da resposta ao estímulo auditivo e dos reflexos palpebral e corneano e cisatracúrio na dose de 0,15 mg.kg-1 . Foram registrados os dados demográficos, os sinais vitais (PAS, PAM, PAD, FC e SpO2) e o tempo de latência do cisatracúrio pelo método da aceleromiogarfia (T1< 5% do controle). O nível de significância utilizado foi de 5%. Resultados: os grupos foram homogêneos com relação aos dados demográficos. Houve diminuição...
Justification and Objectives: the beginning of action of neuromuscular blocking agents may be influenced by factors including the distance from the muscle to the heart, muscle blood flow and cardiac output. Propofol may cause systemic hypotension, particularly when associated with an opioid, which would decrease muscle blood flow and, hence, it has been cited as a factor responsible for the increase in the onset time of neuromuscular blocking agents. This study aimed at evaluating the efficacy of ephedrine in the prevention of systemic hypotensive effects induced by the association of propofol and remifentanil as well as the effects on the onset time of cisatracurium. Method: sixty patients were selected. They were 18 to 52 years old, exhibited ASA physical status I or II and would be submitted to elective surgery under general anesthesia. The patients were randomly allocated into three groups. The distribution of patients was carried out according to the solution used during anesthesia induction, as follows: G I (n=20) - 1% propofol; G II (n=20) - 1% propofol + 0.5 mg.ml-1 ephedrine and G III (n=20) - 1% propofol + 1.0 mg.ml-1 ephedrine. Following pre-oxygenation with O2 at 100% by facial mask, remifentanil was administered by venous continuous infusion (0.5 mg.kg-1.min-1) for 90 seconds. Next, 1% propofol was administered (associated with ephedrine or not), at an infusion rate equal to 180 ml.h-1 until the response to auditory stimuli and palpebral and corneal reflexes could not be detected; a dose of 0.15 mg.kg-1 of cisatracurium was also administered. Demographic data, vital signs (SBP, MBP, DBP, HR and SpO2) and the onset time of cisatracurium were recorded by the acceleromiography method (T1< 5% of the control). The level of significance used was of 5%.Results: the groups were homogeneous as regards the demographic data. There was a statistically significant... (Complete abstract click electronic access below)
Justification and Objectives: the beginning of action of neuromuscular blocking agents may be influenced by factors including the distance from the muscle to the heart, muscle blood flow and cardiac output. Propofol may cause systemic hypotension, particularly when associated with an opioid, which would decrease muscle blood flow and, hence, it has been cited as a factor responsible for the increase in the onset time of neuromuscular blocking agents. This study aimed at evaluating the efficacy of ephedrine in the prevention of systemic hypotensive effects induced by the association of propofol and remifentanil as well as the effects on the onset time of cisatracurium. Method: sixty patients were selected. They were 18 to 52 years old, exhibited ASA physical status I or II and would be submitted to elective surgery under general anesthesia. The patients were randomly allocated into three groups. The distribution of patients was carried out according to the solution used during anesthesia induction, as follows: G I (n=20) - 1% propofol; G II (n=20) - 1% propofol + 0.5 mg.ml-1 ephedrine and G III (n=20) - 1% propofol + 1.0 mg.ml-1 ephedrine. Following pre-oxygenation with O2 at 100% by facial mask, remifentanil was administered by venous continuous infusion (0.5 mg.kg-1.min-1) for 90 seconds. Next, 1% propofol was administered (associated with ephedrine or not), at an infusion rate equal to 180 ml.h-1 until the response to auditory stimuli and palpebral and corneal reflexes could not be detected; a dose of 0.15 mg.kg-1 of cisatracurium was also administered. Demographic data, vital signs (SBP, MBP, DBP, HR and SpO2) and the onset time of cisatracurium were recorded by the acceleromiography method (T1< 5% of the control). The level of significance used was of 5%.Results: the groups were homogeneous as regards the demographic data. There was a statistically significant... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Anestesiologia, Anestesicos - Efeito fisiologico, Anestesia, Anesthetics - propofol, Neuromuscular blockers - cisatracurium, Pharmacokinetic
Como citar
MORO, Eduardo Toshiyuki. Efeito do propofol associado à efedrina no tempo da latência do cisatracúrio. 2006. 102 f. Dissertação (mestrado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2006.