Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/69c2d3e8a953951ba9196e49
Brazilian Journal of Anesthesiology
Scientific Article

Análise das Vantagens de Duas Técnicas Anestésicas - Venosa e Inalatória - Para Colecistectomia por Videolaparoscopia

Analysis of the Advantages of Two Anesthetic Techniques - Venous and Inhalational - for Laparoscopic Cholecystectomy

Andrea Albres Stolf, Yara Marcondes Machado Castiglia, Luciano Brandão Machado

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Resumo

Justificativa e Objetivos - É importante conterem-se os gastos no atendimento à saúde, sem perder a qualidade. O propofol é um hipnótico que promove rápida recuperação da anestesia e sabe-se que é alto o custo operacional de sala de recuperação pós-anestésica (SRPA). O objetivo deste trabalho é verificar as vantagens de se anestesiar com propofol contínuo ou com isoflurano, levando-se em conta os custos das duas técnicas e o tempo de permanência na SRPA. Método - Computou-se o custo total das anestesias para colecistectomia por laparoscopia de 47 pacientes, estado físico ASA I, II, III, divididos em 2 grupos, segundo o agente de manutenção empregado: G1, propofol em infusão contínua convencional (100 a 150 g.kg-1 .min-1 ) e G2, isoflurano. Todos os pacientes foram induzidos com sufentanil (1g.kg-1) e propofol (2 mg.kg-1) e mantidos em circuito com reinalação (fluxo de gás fresco de 2 L.min-1) com 50% de N2O em O2, sufentanil (0,01 g.kg-1.min-1) e atracúrio (0,5 mg. kg-1) ou pancurônio (0,1 mg.kg-1), para os asmáticos. Todos receberam atropina e neostigmina ao final da cirurgia. Ondansetron, dipirona e tenoxicam foram administrados profilaticamente. Quando necessário, utilizaram-se tramadol e N-butilescopolamina. Computaram-se, para G1 e G2, os custos dos agentes utilizados (CUSTO), o tempo total de permanência na SRPA (t-SRPA) e aquele após a extubação (t-EXT). Resultados - Quanto ao custo, G1>G2, de modo estatisticamente significativo; quanto ao t-SRPA, G1

Palavras-chave

ANESTÉSICOS, Volátil: isoflurano; HIPNÓTICOS: propofol; TÉCNICAS ANESTÉSICAS, Venosa, Inalatória

Abstract

Background and Objectives - It is essential to reduce health care costs without impairing the quality of care. Propofol is associated to faster recovery and it is known that post-anesthesia care unit (PACU) costs are high. The aim of this study was to evaluate the advantages of two anesthesia regimens - propofol continuous infusion or isoflurane - taking into account the cost of both techniques on PACU stay. Methods - Forty seven patients, physical status ASA I, II and III, undergoing laparoscopic cholecystectomy were divided into 2 groups according to the anesthetic agent: G1, conventional propofol continuous infusion (100-150 µg.kg-1.min-1) and G2, isoflurane. All patients were induced with sufentanil (1 µg.kg-1) and propofol (2 mg.kg-1) and were kept in a re-inhalation circuit (2 L.min-1 of fresh gas flow) with 50% N2O in O2, sufentanil (0.01 µg.kg-1.min-1) and atracurium (0.5 mg.kg-1), or pancuronium (0.1 mg.kg-1) for asthma patients. All patients received atropine and neostigmine at the end of the surgery. Prophylactic ondansetron, dipyrone and tenoxican were administered and, when necessary, tramadol and N-butylscopolamine. Costs of anesthetic drugs (COST), total PACU stay (t-PACU), and PACU stay after extubation (t-EXT) were computed for both groups. Results - Costs were significantly lower in the isoflurane group but t-PACU was 26 minutes longer and t-EXT G1

Keywords

 ANESTHETICS, Volatile: isoflurane; ANESTHETIC TECHNIQUES, Venous, Inhalational; HYPNOTICS: propofol

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