Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000100009
Brazilian Journal of Anesthesiology
Miscellaneous

Sedação com propofol e alfentanil para litotripsia extracorpórea por ondas de choque

Propofol and alfentanil sedation for extracorporeal shock wave lithotripsy

José Roberto Nociti; Sérgio Neves Zuccolotto; Carlos André Cagnolati; Antônio Carlos Moura Oliveira; Maurício Mahalem Bastos

http://dx.doi.org/10.1590/S0034-70942002000100009 Braz J Anesthesiol, vol.52, n1, p.74-78, 2002
PDF Português
PDF English
Downloads: 0
Views: 1254

Resumo

JUSTIFICATIVA E OBJETIVOS: Este estudo não-comparativo tem por objetivo pesquisar as doses adequadas de propofol e alfentanil em sedação para litotripsia extracorpórea por ondas de choque (LEOC) bem como o tempo necessário para a alta hospitalar. MÉTODO: Foram observados 24 pacientes consecutivos de ambos os sexos submetidos a LEOC em regime ambulatorial, com estado físico ASA I ou II, sob sedação por via venosa com propofol na dose inicial de 1 mg.kg-1, seguida de infusão contínua com velocidade variável, e alfentanil na dose inicial de 15 µg.kg-1, seguida de bolus adicionais de 5 µg.kg-1 conforme as necessidades clínicas. Monitorização de SpO2, PAS, PAD e FC por método não-invasivo e alta hospitalar conforme critérios propostos por Kortilla para pacientes ambulatoriais. RESULTADOS: A duração média dos procedimentos foi de 46,8 ± 12,8 minutos. As doses totais médias de propofol e de alfentanil foram respectivamente de 59,0 ± 17,9 µg.kg-1.min-1 e 0,38 ± 0,14 µg.kg-1.min-1. Alta hospitalar em até 60 minutos em 58,3% dos casos; de 61 a 90 minutos em 20,9%; de 91 a 120 minutos em 12,5%; e acima de 120 minutos em 8,3%. Ocorreu dessaturação do sangue arterial (SpO2 £ 85%) em pelo menos uma ocasião em 45,8% dos pacientes, com rápida recuperação após fornecimento de oxigênio a 100%. CONCLUSÕES: A sedação com propofol e alfentanil nas doses relatadas para LEOC constitui método prático, efetivo e seguro desde que adotadas medidas para monitorização e atendimento a complicações cardiorrespiratórias que podem ocorrer no curso do procedimento.

Palavras-chave

HIPNÓTICOS, PROCEDIMENTOS DE DIAGNOSE E TERAPIA, SEDAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: This non comparative study aimed at investigating optimal propofol and alfentanil doses used for sedation during extracorporeal shock wave lithotripsy (ESWL) as well as the time elapsed for hospital discharge. METHODS: Participated in this study 24 consecutive outpatients of both genders, physical status ASA I or II, submitted to ESWL under intravenous sedation. Sedation consisted of propofol (initial dose of 1 mg.kg-1 followed by continuous infusion with variable speed), and alfentanil (initial dose of 15 µg.kg-1 followed by additional 5 µg.kg-1 boluses according to clinical needs). Non invasive SpO2, SBP, DBP, and HR were monitored, and hospital discharge was provided according to Kortilla’s criteria for outpatient surgeries. RESULTS: Mean procedure duration was 46.8 ± 12.8 minutes. Mean total propofol and alfentanil doses were 59.0 ± 17.9 µg.kg-1.min-1 and 0.38 ± 0.14 µg.kg-1.min-1, respectively. Time for hospital discharge was 60 min or less in 58.3% of patients; 61 to 90 minutes in 20.9%; 91 to 120 minutes in 12.5%; and more than 120 minutes in 8.3%. There has been at least one episode of low arterial blood saturation (SpO2 £ 85%) in 45.8% of patients followed by quick reversion after 100% oxygen supply. CONCLUSIONS: Propofol and alfentanil in the doses reported are practical, effective, and safe for ESWL anesthesia, provided respiratory and cardiovascular parameters are monitored and devices for treating complications are readily avaiable.

Keywords

DIAGNOSIS AND THERAPEUTIC PROCEDURES, HYPNOTICS, SEDATION

References

Grove TM, Katz RL. Anaesthesia for Urological Surgery. International Practice of Anaesthesia. 1996;116:5-7.

London RA, Kudlak T, Riehle RA. Immersion anesthesia for extracorporeal shock-wave lithotripsy: review of two hundred twenty treatments. Urology. 1986;28:86-94.

Pandit SK, Powell RB, Crider B. Epidural fentanyl: a simple and novel approach to anesthetic management for extracorporeal shock-wave lithotripsy (ESWL). Anesthesiology. 1987;67:A225.

Bromage PR, Al-Faqil S, Kadiwal GH. Evaluation of bupivacaine and fentanyl epidural analgesia for extracorporeal shock wave lithotripsy (ESWL). Anesthesiology. 1987;67:A226.

Loening S, Kramolowsky EV, Willoughby B. Use of local anesthesia for extracorporeal shock wave lithotripsy. J Urol. 1987;137:626-628.

Malhotra V, Long CW, Meister MJ. Intercostal blocks with local infiltration anesthesia for extracorporeal shock wave lithopsy. Anesth Analg. 1987;66:85-88.

Abbott MA, Samuel JR, Webb DR. Anesthesia for extracorporeal shock wave lithotripsy. Anaesthesia. 1985;40:1065-1072.

Monk TG, Bowe JM, White PF. Comparison of intravenous sedation-analgesia techniques for outpatient immersion lithotripsy. Anesth Analg. 1991;72:616-621.

Pereira AMSA, Gonçalves TAM, Cangiani LM. Anestesia fora do centro cirúrgico e para procedimentos diagnósticos e terapêuticos. Rev Bras Anestesiol. 2000;50:149-166.

Kortilla K. Recovery from day case anaesthesia. Anaesthesia. 1995;50(^sSuppl):22-28.

Freilich JD, Brull SJ, Schiff S. Anesthesia for lithotripsy: efficacy of monitored anesthesia care with alfentanil. Anesth Analg. 1990;70:S115.

Monk TG, Rater JM, White PF. Comparison of alfentanil and ketamine infusions in combination with midazolam for outpatient lithotripsy. Anesthesiology. 1991;74:1023-1028.

Richardson MG, Dooley JW. The effects of general versus epidural anesthesia for outpatient extracorporeal shock wave lithotripsy. Anesth Analg. 1998;86:1214-1218.

5dd59a8a0e88257e0ac8fca8 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections