Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000300001
Brazilian Journal of Anesthesiology
Scientific Article

Ação do óxido nitroso no sistema nervoso central: estudo eletrofisiológico como agente único e como agente coadjuvante

Nitrous oxide action on the central nervous system: electrophysiological study as a sole agent or a coadjuvant

Verônica Vieira da Costa; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942002000300001 Braz J Anesthesiol, vol.52, n3, p.255-271, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: O óxido nitroso é o agente anestésico inalatório mais utilizado em todo o mundo. Seu mecanismo de ação é bastante discutido, com base em resultados experimentais e em evidências clínicas. O objetivo deste estudo é avaliar a ação eletrofisiológica deste fármaco no Sistema Nervoso Central através de monitorização específica. MÉTODO: Foram estudados vinte e cinco pacientes de ambos os sexos, com idades entre 6 e 25 anos, submetidos à cirurgia ortopédica ou plástica reparadora, os quais foram monitorizados com índice bispectral do eletroencefalograma (BIS) e potencial evocado somatossensitivo (PESS) durante a anestesia. Foram realizados registros basais do BIS e do PESS, bem como após o uso do óxido nitroso em fracionais alveolares (FA) de 30%, 50% e 66%. Em seguida o óxido nitroso era descontinuado e administrado aleatoriamente isoflurano ou desflurano em 0,5 CAM e 1 CAM. Mantinha-se 1 CAM do determinado agente e o óxido nitroso era novamente administrado nas mesmas concentrações anteriores. RESULTADOS: O óxido nitroso quando utilizado como agente único, produz uma redução no BIS que, embora seja estatisticamente significante, não expressa um estado de hipnose. Esta redução também ocorre quando utilizado como agente coadjuvante mas sem importância clínica. Como agente único, o óxido nitroso deprimiu significantemente a amplitude das ondas cerebrais, sem promover aumento na latência. O isoflurano e desflurano reduziram a amplitude e aumentaram a latência das ondas cerebrais. A associação do óxido nitroso a estes agentes, intensificou ainda mais estes efeitos nas ondas corticais. Não houve alteração significativa das ondas periférica e medular do PESS. CONCLUSÕES: O óxido nitroso tem uma pequena ação hipnótica, que não é captada completamente pelo BIS. Tem ação acentuada nas estruturas corticais, tanto como agente único como associado ao isoflurano e desflurano, o que pode explicar o seu bom efeito analgésico.

Palavras-chave

ANESTÉSICOS, ANESTÉSICOS, MONITORIZAÇÃO, MONITORIZAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: Nitrous oxide is the most widely used inhalational anesthetic worldwide. Its action mechanism is broadly discussed based on results of experimental studies and clinical evidences. The purpose of this study was to evaluate, through specific monitoring, nitrous oxide electrophysiological action on the central nervous system. METHODS: Twenty-five patients of both genders, aged 6 to 25 years, undergoing orthopedic or corrective plastic surgery, were monitored by electroencephalogram bispectral index (EEG-BIS) and somatosensory evoked potential (SEP) during anesthesia. BIS and SEP baseline values were recorded, as well as after fractional alveolar (FA) 30%, 50% and 66% nitrous oxide administration. Then, nitrous oxide was withdrawn and isoflurane or desflurane were randomly administered in 0.5 and 1 MAC. While maintaining 1 MAC of one of those agents, nitrous oxide was again administered in the same previous concentrations. RESULTS: Nitrous oxide as sole agent caused a BIS decrease which, although statistically significant, did not represent a hypnotic state. This decrease was also observed when nitrous oxide was used as a coadjuvant agent, however without clinical significance. As sole agent, nitrous oxide significantly depressed brain waves amplitude, with no increase in onset time. Isoflurane and desflurane decreased the amplitude and increased onset time of brain waves. The association of nitrous oxide to those agents further increased these effects on cortical waves. There were no significant changes in peripheral and spinal cord SEP waves. CONCLUSIONS: Nitrous oxide has a minor hypnotic action, which is not completely captured by EEG-BIS. It has a pronounced action on cortical structures, both as sole agent or associated to isoflurane or desflurane, which may explain its satisfactory analgesic effect.

Keywords

ANESTHETICS, ANESTHETICS, MONITORING, MONITORING

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