Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000400006
Brazilian Journal of Anesthesiology
Scientific Article

Comparação entre nifedipina por via sublingual e clonidina por via venosa no controle de hipertensão arterial peri-operatória em cirurgias de catarata

Comparison between sublingual nifedipine and intravenous clonidine to control perioperative arterial hypertension in cataract procedures

Renato Mestriner Stocche; Luis Vicente Garcia; Jyrson Guilherme Klamt; Alexandre Pachione; H Yu Huang; Waleska A Oliveira

http://dx.doi.org/10.1590/S0034-70942002000400006 Braz J Anesthesiol, vol.52, n4, p.426-433, 2002
PDF
Downloads: 0
Views: 1340

Resumo

JUSTIFICATIVA E OBJETIVOS: Estudo recente mostra que a clonidina por via venosa apresenta-se eficaz e segura no tratamento de crises hipertensivas durante cirurgia de catarata. Este estudo visa comparar o uso de nifedipina, droga amplamente utilizada por via sublingual, e clonidina por via venosa no controle da hipertensão arterial em cirurgias de catarata. MÉTODO: Setenta e cinco pacientes submetidos à facectomia foram distribuídos de forma aleatória e encoberta em: Grupo A, que recebeu nifedipina e Grupos C2 e C3, que receberam, respectivamente, 2 e 3 µg.kg-1 de clonidina por via venosa. Todos os pacientes apresentavam hipertensão arterial (PAS > 170 mmHg ou PAD > 110 mmHg). As PAS, PAD e freqüência cardíaca (FC) foram medidas e comparadas nos momentos: 0 (antes do tratamento) e de 2 em 2 minutos até o final do procedimento. Os eventos adversos foram anotados. RESULTADOS: Após o tratamento ocorreram diminuições da PAS e PAD nos 3 grupos (p <0,001). Houve controle da pressão arterial (<160 mmHg) em 32%, 64% e 72% dos pacientes nos grupos A, C2 e C3, respectivamente (p < 0,05). No grupo C3 ocorreu maior incidência de efeitos colaterais que nos grupos C2 e A (p < 0,05). CONCLUSÕES:A clonidina por via venosa é mais eficaz que a nifedipina, por via sublingual, no controle de crises hipertensivas no peri-operatório de cirurgias de catarata. Contudo, a dose de 3 µg.kg-1 pode estar relacionada a efeitos colaterais, devendo-se iniciar o tratamento com 2 µg.kg-1.

Palavras-chave

CIRURGIA, CIRURGIA, COMPLICAÇÕES, COMPLICAÇÕES, COMPLICAÇÕES, DROGAS, DROGAS

Abstract

BACKGROUND AND OBJECTIVES: A recent study has shown that intravenous clonidine is effective and safe in treating perioperative arterial hypertension during cataract procedures. This study aimed at comparing sublingual nifedipine and intravenous clonidine to control arterial hypertension during cataract procedures. METHODS: Participated in this randomized double-blind study 75 patients submitted to facectomy, who were distributed in: Group A, receiving nifedipine and Groups C2 and C3, receiving 2 and 3 µg.kg-1 intravenous clonidine, respectively. All patients had arterial hypertension (SBP > 170 mmHg or DBP > 110 mmHg). SBP, DBP and HR were monitored and compared in moments 0 (before treatment), and at 2-minute intervals until the end of the procedure. Adverse events were recorded. RESULTS: There has been SBP and DBP decrease in all groups after treatment (p < 0.001). There has been blood pressure control (< 160 mmHg) in 32%, 64% and 72% of groups A, C2 and C3 patients, respectively (p < 0.05). Group C3 presented a higher incidence of side-effects, as compared to groups C2 and A (p < 0.05). CONCLUSIONS: Intravenous clonidine is more effective than sublingual nifedipine to control perioperative arterial hypertension during cataract extraction. However, the dose of 3 µg.kg-1 may be related to side-effects and treatment should be started with 2 µg.kg-1.

Keywords

COMPLICATIONS, COMPLICATIONS, COMPLICATIONS, DRUGS, DRUGS, SURGERY, SURGERY

References

Stocche RM, Garcia LV, Klamt JG. Clonidina venosa no controle da hipertensão arterial perioperatória em cirurgias de catarata: Estudo retrospectivo. Rev Bras Anestesiol. 2000;50:289-293.

Stocche RM, Garcia LV, Klamt JG. Medicação pré-anestésica com clonidina por via oral em cirurgia de catarata. Rev Bras Anestesiol. 2000;50:278-282.

Reves JG. The relative hemodynamic effects of CA++ entry blockers. Anesthesiology. 1984;61:3.

Sperduto RD, Seigel D. Senile lens and senile macular changes in a populational-based sample. Am J Ophthalmol. 1980;90:86-91.

Drolsum L, Haaskjold E. The influence of age on characteristics of cataract patients. Acta Ophthalmol. 1994;72:622-626.

Pascoe PJ, Ilkiw JE, Stiles J. Arterial hypertension associated with topical ocular use of phenylephrine in dogs. J Am Vet Med Assoc. 1994;205:1562-1564.

Laurito CE, Baughman VL, Becker GL. The effectiveness of oral clonidine as a sedative/anxiolytic and as a drug to blunt the hemodynamic responses to laringoscopy. J Clin Anesth. 1991;3:186-193.

Ghignone M, Noe C, Calvillo O. Anesthesia for ophthalmic surgery in the elderly: the effects of clonidine on intraocular pressure, perioperative hemodynamics, and anesthetic requirement. Anesthesiology. 1988;68:707-716.

Howie MB, Hiestand DC, Jopling MW. Effect of oral clonidine pre medication on anesthetic requirement, hormonal response, hemodynamics, and recovery in coronary artery bypass graft surgery patients. J Clin Anesth. 1996;8:263-272.

Lawrence CJ, Prinzen FW, de Lange S. Effects of the specific alpha2 adrenergic agonist dexmedetomidine on the systemic and coronary circulation of the anesthetized goat. J Cardiothorac Vasc Anesth. 1992;92:75.

Davies DS, Wing LMH, Reid JL. Pharmacokinetics and concentration-effect relationships of intravenous and oral clonidine. Clin Pharmacol Ther. 1977;21:593-601.

Stühmeier K D, Mainzer B, Cierpka J. Small, oral dose of clonidine reduces the Incidence of intraoperative myocardial ischemia in patients having vascular surgery. Anesthesiology. 1996;85:706-712.

5dd587f40e88258441c8fca6 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