Influência da dexmedetomidina na concentração expirada do sevoflurano: avaliação pelo índice bispectral, taxa de supressão e análise espectral da potência do eletroencefalograma

Rogean Rodrigues Nunes; Sara Lúcia Cavalcante

doi:10.1590/S0034-70942002000200001

Scientific Article

Influência da dexmedetomidina na concentração expirada do sevoflurano: avaliação pelo índice bispectral, taxa de supressão e análise espectral da potência do eletroencefalograma

Influence of dexmedetomidine upon sevoflurane end-expiratory concentration: evaluation by bispectral index, suppression rate and electroencephalographic power spectral analysis

Rogean Rodrigues Nunes; Sara Lúcia Cavalcante

http://dx.doi.org/10.1590/S0034-70942002000200001 Braz J Anesthesiol, vol.52, n2, p.133-145, 2002

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Resumo

JUSTIFICATIVA E OBJETIVOS: A dexmedetomidina, um alfa2-agonista adrenérgico, tem sido descrita como capaz de reduzir o consumo tanto de agentes venosos como inalatórios. O objetivo deste estudo foi avaliar a influência da dexmedetomidina na concentração expirada (CE) do sevoflurano, com monitorização da profundidade da anestesia. MÉTODO: Participaram do estudo 40 pacientes do sexo feminino, estado físico ASA I, submetidas à laparoscopia ginecológica sob anestesia geral mantida com sevoflurano, divididas aleatoriamente em dois grupos: Grupo I (20): sem dexmedetomidina, e Grupo II (20): com dexmedetomidina em infusão contínua no seguinte esquema: Fase rápida (1 µg.kg-1 em 10 minutos), 10 minutos antes da indução da anestesia, seguida por uma fase de manutenção (0,4 µg.kg-1.h-1) até o final da cirurgia. Foram analisados os seguintes parâmetros: PA, FC, BIS, SEF 95%, amplitude relativa na freqüência de banda delta (delta %), taxa de supressão (TS), rSO2, CE, SpO2 e P ET CO2, nos seguintes momentos: M1 - antes da infusão da dexmedetomidina ou solução fisiológica a 0,9%, M2: antes da intubação traqueal (IT), M3: após a IT, M4: antes da incisão, M5: após a incisão, M6: antes da insuflação do CO2, M7: após a insuflação de CO2, M8: 10 minutos após a insuflação de CO2, M9: 10 min após M8, M10: 20 min após M8, M11: 30 min após M8, M12: 40 min após M8 e M13: ao despertar. Anotamos também o tempo de despertar e de alta hospitalar. RESULTADOS: A dexmedetomidina reduziu a concentração expirada de sevoflurano de M4 até M13 (p<0,05), comparando-se GI e GII. Não foram observadas mudanças clinicamente significativas nos parâmetros hemodinâmicos. O tempo de despertar no GI foi 11 ± 0,91 minutos e no GII foi 6,35 ± 0,93 minutos (p < 0,05). O tempo de alta hospitalar no GI foi 7,45 ± 0,69 horas e no GII foi 8,37 ± 0,88 horas (p < 0,05). CONCLUSÕES: A dexmedetomidina é efetiva em reduzir a concentração expirada do sevoflurano, mantendo estabilidade hemodinâmica, sem comprometer o tempo de alta hospitalar, além de promover um despertar mais precoce.

Palavras-chave

ANALGÉSICOS, ANESTÉSICOS, Volátil, MONITORIZAÇÃO, MONITORIZAÇÃO, MONITORIZAÇÃO, MONITORIZAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Dexmedetomidine, an alpha2-adrenergic agonist, has been described as being able to decrease the demand for both venous and inhalational agents. This study aimed at evaluating the influence of Dexmedetomidine upon sevoflurane end-expiratory concentration (EC) with monitoring the depth of anesthesia. METHODS: Participated in this study 40 female adult patients, physical status ASA I, submitted to gynecological laparoscopy under general anesthesia maintained with sevoflurane, who were randomly divided in two groups: Group I (n=20), without dexmedetomidine; and Group II (n=20), with dexmedetomidine, in continuous infusion, as follows: Rapid phase (1 µg.kg-1 in 10 min-1) 10 minutes before anesthesia induction, followed by a maintenance phase (0,4 µg.kg-1.h-1) throughout the surgery. The following parameters were analyzed: BP, HR, BIS, SEF 95%, delta%, suppression rate (SR), rSO2, CE, SpO2 and P ET CO2, in the following moments: M1 - before dexmedetomidine or 0.9% saline infusion; M2 - prior to intubation; M3 - following intubation; M4 - before incision; M5 - following incision; M6 - before CO2 inflation; M7 - following CO2 inflation; M8 - 10 min after CO2 inflation; M9 - 10 min after M8; M10 - 20 min after M8; M11 - 30 min after M8; M12 - 40 min after M8; and M13 - at emergence. Time for emergence and hospital discharge were also recorded. RESULTS: Dexmedetomidine has decreased sevoflurane end-expiratory concentration from M4 to M13 (p<0.05) when comparing Group I and Group II. No clinically significant changes were observed in hemodynamic parameters. Time for emergence in Groups I and II was 11 ± 0.91 min. and 6.35 ± 0.93 min., respectively (p < 0.05). Time for hospital discharge was 7.45 ± 0.69 h in Group I and 8.37 ± 0.88 h in Group II (p < 0.05). CONCLUSIONS: Dexmedetomidine was effective in decreasing sevoflurane end-expiratory concentration while maintaining hemodynamic stability without impairing time for hospital discharge, in addition to promoting an earlier emergence.

Keywords

ANALGESICS, ANESTHETICS, Volatile, MONITORING, MONITORING, MONITORING, MONITORING

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Influência da dexmedetomidina na concentração expirada do sevoflurano: avaliação pelo índice bispectral, taxa de supressão e análise espectral da potência do eletroencefalograma

Influence of dexmedetomidine upon sevoflurane end-expiratory concentration: evaluation by bispectral index, suppression rate and electroencephalographic power spectral analysis

Rogean Rodrigues Nunes; Sara Lúcia Cavalcante

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