Influência do Sevoflurano e do Isoflurano na Duração do Bloqueio Neuromuscular Produzido pelo Rocurônio
Influence of Sevoflurane and Isoflurane in Rocuronium-Induced Neuromuscular Block Duration
Angélica de Fátima de Assunção Braga, Glória Maria Braga Potério, Franklin Sarmento da Silva Braga, Eugesse Cremonesi, Alessandra Klautau
Resumo
Justificativa e Objetivos - Os efeitos dos agentes bloqueadores neuromusculares sobre a junção neuromuscular são potencializados por anestésicos voláteis, de forma dose dependente. O objetivo deste estudo foi avaliar a influência do sevoflurano e do isoflurano na recuperação do bloqueio neuromuscular produzido pelo rocurônio. Método - Foram estudados 60 pacientes, estado físico ASA I e II, submetidos a cirurgias eletivas sob anestesia geral, distribuídos em dois grupos de acordo com o agente volátil empregado: Grupo I (sevoflurano) e Grupo II (isoflurano). Todos os pacientes receberam midazolam (0,1 mg.kg-1) por via muscular como medicação pré-anestésica, 30 minutos antes da cirurgia. A indução anestésica foi obtida com propofol (2,5 mg.kg-1) precedido de alfentanil (50 g.kg-1) e rocurônio (0,6 mg.kg-1). Os pacientes foram ventilados com oxigênio a 100% sob máscara até o desaparecimento das quatro respostas à seqüência de quatro estímulos (SQE), quando foram realizadas as manobras de laringoscopia e intubação traqueal. Os agente voláteis para a manutenção da anestesia foram introduzidos logo após a intubação traqueal e empregados nas concentrações de 2% e 1%, respectivamente para o sevoflurano e isoflurano, em mistura de O2 e N2O a 50%. Doses adicionais de fentanil foram administradas na vigência de sinais clínicos de anestesia superficial. Os pacientes foram ventilados mecanicamente para manter PETCO2 entre 32 e 36 mmHg. Foram medidas as temperaturas corpórea e da pele sobre a região hipotenar do lado monitorizado, que se mantiveram acima de 35 e 32 C, respectivamente. A função neuromuscular foi monitorizada com aceleromiografia, empregando-se a SQE a cada 15 segundos. Foram avaliados: a duração clínica do bloqueio neuromuscular (T125%) e o índice de recuperação (IR= T125-75%). Resultados - Os tempos médios e desvios padrão para a duração clínica (T125%) e índice de recuperação (T125-75%) foram: Grupo I (38,73 5,39 min e 26,30 3,55 min) e Grupo II (32,76 6,5 min e 14,74 4,34 min). Em relação ao índice de recuperação houve diferença significante entre os grupos. Conclusões - O sevoflurano prolonga mais a duração do bloqueio neuromuscular produzido pelo rocurônio, quando comparado ao isoflurano, evidenciado pelo significante aumento do índice de recuperação.
Palavras-chave
Abstract
Background and Objectives - The effects of neuromuscular blocking agents on the neuromuscular junction are dose-dependently increased by volatile anesthetic agents. This study aimed at evaluating the influence of sevoflurane and isoflurane in rocuronium-induced neuromuscular block recovery. Methods - Participated in this study 60 patients, physical status ASA I and II, submitted to elective surgeries under general anesthesia, who were distributed in two groups according to the volatile agent used: Group I (sevoflurane) and Group II (isoflurane). All patients were premedicated with IM midazolam (0.1 mg.kg-1) 30 minutes before surgery. Anesthesia was induced with alfentanil (50 g.kg-1) and propofol (2.5 mg.kg-1), followed by rocuronium (0.6 mg.kg-1). Patients were ventilated with 100% oxygen under mask until total disappearance of responses to TOF stimulation, when laryngoscopy and tracheal intubation were performed. Volatile agents for anesthesia maintenance were introduced soon after tracheal intubation in the concentrations of 2% and 1%, respectively, for sevoflurane and isoflurane, in a mixture of 50% O2 and N2O. Additional fentanyl doses were administered in the presence of clinical signs of superficial anesthesia. Mechanical ventilation was adjusted to maintain PETCO2 between 32 and 36 mmHg. Body and skin temperature on the hipothenar region of the monitored side were measured and remained above 35 and 32 o C, respectively. Neuromuscular function was monitored through acceleromyography, with TOF stimulation at every 15 seconds. Neuromuscular block duration (T125%) and recovery index (RI=T125-75%) were evaluated. Results - Mean times and standard deviations for clinical duration (T125%) and recovery index (RI=T125-75%) were: Group I (38.73 5.39 min and 26.30 3.55 min) and Group II (32.76 6.5 min and 14.74 4.34 min). There has been a significant difference between groups as to recovery index. Conclusions - Sevoflurane prolongs rocuronium-induced neuromuscular block as compared to isoflurane, what was evidenced by the significant increase in recovery index.
Keywords
References
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