Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942002000500002
Brazilian Journal of Anesthesiology
Artigo Científico

Dexmedetomidina e sufentanil como analgésicos per-operatórios: estudo comparativo

Dexmedetomidine and sufentanil as intraoperative analgesics: comparative study

Fábio Geraldo Curtis; Yara Marcondes Machado Castiglia; Andrea Albres Stolf; Erick Ronzella; Simone Maria D’Angelo Vanni; Paulo do Nascimento Junior

http://dx.doi.org/10.1590/S0034-70942002000500002 Braz J Anesthesiol, vol.52, n5, p.525-534, 2002
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Resumo

JUSTIFICATIVA E OBJETIVOS: A utilização das drogas agonistas dos alfa2-adrenoceptores para controlar a pressão arterial e freqüência cardíaca, propiciar menores respostas hemodinâmicas à intubação e extubação traqueal e poupar anestésicos já está difundida na literatura desde a introdução da clonidina. O desenvolvimento de agentes providos de maior seletividade alfa2-adrenoceptora que, por isso, determinam menos efeitos adversos, como a dexmedetomidina, recentemente liberada para utilização clínica, possibilitou que ocorressem maior sedação e analgesia com o seu uso. Despertou-se, então, o interesse em sua utilização como substitutos dos opióides, conhecidos por determinarem potente analgesia e sedação. O objetivo deste trabalho foi comparar a analgesia promovida pela dexmedetomidina e pelo sufentanil, utilizados em infusões contínuas durante anestesias de procedimentos otorrinolaringológicos e de cabeça e pescoço. MÉTODO: Os 60 pacientes estudados foram divididos em dois grupos de 30: G1, recebendo sufentanil e G2, dexmedeto- midina, na indução e manutenção anestésicas. Para a manutenção da anestesia utilizaram-se, também, o óxido nitroso e o propofol, em infusão contínua alvo-controlada. Foram avaliados os parâmetros hemodinâmicos (pressões arteriais sistólica e diastólica e freqüência cardíaca), tempos de despertar e de extubação após interrupção do propofol, locais onde foram extubados os pacientes, sala de operação (SO) ou sala de recuperação pós-anestésica (SRPA), tempo de permanência na SRPA, índice de Aldrete e Kroulik e as complicações apresentadas na SO e SRPA. RESULTADOS: G1 apresentou menores valores de pressões arteriais sistólica, diastólica e freqüência cardíaca, tempos de despertar e extubação maiores, maior número de extubações na SRPA, maior tempo de permanência na SRPA, valores mais baixos para Aldrete e Kroulik na alta da SRPA e mais complicações per e pós-operatórias. CONCLUSÕES: A utilização de dexmedetomidina como analgésico per-operatório apresentou melhores resultados que a de sufentanil, nos procedimentos selecionados neste trabalho, com relação à estabilidade hemodinâmica e às condições de despertar e de recuperação anestésica.

Palavras-chave

ANALGÉSICOS, ANALGÉSICOS, DROGAS

Abstract

BACKGROUND AND OBJECTIVES: The use of alpha2-agonists to control heart rate and blood pressure, to attenuate hemodynamic responses to tracheal intubation and extubation and to reduce anesthetics requirement are already well established in the literature since clonidine introduction for therapeutic use. Dexmedetomidine, recently approved for clinical use, presents more alpha2-adrenergic receptors selectively, and therefore less adverse effects combined with marked analgesic and sedative properties. This has raised the interest in using it to replace opioids, known for their potent analgesic and sedative properties. This study aimed at comparing dexmedetomidine and sufentanil analgesia’s during continuous infusion for ENT, head and neck procedures. METHODS: Sixty patients were randomly distributed in two groups of 30: G1 - sufentanil and G2 - dexmedetomidine, for anesthetic induction and maintenance. Nitrous oxide and propofol in a target controlled continuous infusion were also used for anesthetic maintenance. The following parameters were evaluated: hemodynamic variables (systolic, diastolic blood pressure and heart rate), emergence and extubation times after propofol withdrawal, place where patients were extubated (operating room - OR, or post-anesthetic recovery unit - PACU), PACU stay, Aldrete Kroulik index, and OR or PACU complications. RESULTS: G1 had lower systolic and diastolic blood pressure, lower heart rate values, longer emergence and extubation times, higher number of PACU extubations, longer PACU stay, lower Aldrete-Kroulik index and higher number of peri and postoperative complications. CONCLUSIONS: Dexmedetomidine as intraoperative analgesic was more effective as compared to sufentanil in the procedures selected for this study regarding hemodynamic stability, emergence and anesthetic recovery conditions.

Keywords

ANALGESICS, ANALGESICS, DRUGS

Referências

Hall JE, Uhrich TD, Barney JA. Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Anesth Analg. 2000;90:699-705.

Aantaa R, Kallio A, Virtanen R. Dexmedetomidine, a novel a2-adrenergic agonist: A review of its pharmacodynamic characteristics. Drugs of the Future. 1993;18:49-56.

Aantaa R, Kanto J, Scheinin M. Dexmedetomidine, an a2-adrenoceptor agonist, reduces anesthetic requirements for patients undergoing minor gynecologic surgery. Anesthesiology. 1990;73:519-527.

Bailey PL, Egan TD. Fentanyl and congeners. Intravenous anesthesia. 1997:213-245.

Dyck JB, Shafer SL. Dexmedetomidine: pharmacokinetics and pharmacodynamics. Anaesth Pharm Review. 1993;1:238-245.

Bouaziz H, Hewitt C, Eisenach JC. Subarachnoid neostigmine potentiation of alpha 2-adrenergic agonist analgesia: Dexmedetomidine versus clonidine. Reg Anesth. 1995;20:121-127.

Kamibayashi T, Maze M. Clinical uses of a2-adrenergic agonists. Anesthesiology. 2000;93:1345-1349.

Aantaa R. Assessment of the sedative effects of dexmede: tomidine, an a2-adrenoceptor agonist, with analysis of saccadic eye movements. Pharmacol Toxicol. 1991;68:394-398.

Bloor BC, Ward DS, Belleville JP. Effects of intravenous dexmedetomidine in humans: Hemodynamic changes. Anesthesiology. 1992;77:1134-1142.

Dyck JB, Maze M, Haack C. The pharmacokinetics and hemodynamic effects of intravenous and intramuscular dexmedetomidine hydrochloride in adult human volunteers. Anesthesiology. 1993;78:813-820.

Sebel PS, Bovill JG. Cardiovascular effects of sufentanil anesthesia: a study in patients undergoing cardiac surgery. Anesth Analg. 1982;61:115-124.

Blair JR, Pruett JK, Introna RPS. Cardiac electro- physiologic effects of fentanyl and sufentanil in canine cardiac Purkinje fibers. Anesthesiology. 1989;71:565-568.

Hall RI, Murphy JT, Moflitt EA. A comparison of the myocardial metabolic and haemodynamic changes produced by propofol-sufentanil and enflurane-sufentanil anaesthesia for patients having coronary artery bypass graft surgery. Can J Anaesth. 1991;38:996-1002.

Talke P, Li J, Jain U. Effects of perioperative dexme- detomidine infusion in patients undergoing vascular surgery: The study of perioperative ischemia research group. Anesthe- siology. 1995;82:620-633.

Kallio A, Scheinin M, Koulu M. Effects of dexmedetomidine, a selective alpha 2-adrenoceptor agonist, on hemodynamic control mechanims. Clin Pharmacol Ther. 1989;46:33-42.

Nociti JR, Serzedo PS, Nunes AM. Sufentanil em infusão venosa contínua para cirurgias abdominais. Rev Bras Anestesiol. 1995;45:235-243.

Ebert TJ, Hall JE, Barney JA. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anesthesiology. 2000;93:382-394.

Talke P, Richardson CA, Scheinin M. Postoperative pharmacokinetics and sympatholytic effects of dexmedetomidine. Anesth Analg. 1997;85:1136-1142.

Vuyk J, Mertens MJ, Olofsen E. Propofol anesthesia and rational opioid selection. Anesthesiology. 1997;87:1549.

Stolf AA, Castiglia YMM, Machado LB. Análise das vantagens de duas técnicas anestésicas: venosa e inalatória - para colecistectomia por videolaparoscopia. Rev Bras Anestesiol. 2001;51:10-16.

Shafer SL, Varvel JR. Pharmacokinetics, pharmacodynamics, and rational opioid selection. Anesthesiology. 1991;74:53-63.

Bailey Pl, Streisand JB, East KA. Differences in magnitude and duration of opioid-induced respiratory depression and analgesia with fentanyl and sufentanil. Anesth Analg. 1990;70:8.

Shook JE, Watkins WD, Camporesi EM. Differential roles of opioid receptors in respiration, respiratory disease, and opiate-induced respiratory depression. Am Rev Respir Dis. 1990;142:895.

Belleville JP, Wards DS, Bloor BC. Effects of intravenous dexmedetomidine in humans: I. Sedation, ventilation, and metabolic rate.. Anesthesiology. 1992;77:1125-1133.

Chang J, Fish KJ. Acute respiratory arrest and rigidity after anesthesia with sufentanil: A case report. Anesthesiology. 1985;63:710.

Robinson D. Respiratory arrest after recovery from anaesthesia supplemented with sufentanil. Can J Anaesth. 1988;35:101.

Bailey PL, Egan TD, Stanley TH. Intravenous Opiod Anesthetics, em: Miller RD - Anesthesia. 2000:299-300.

Fisher DM. The "big little problem" of postoperative nausea and vomiting. Anesthesiology. 1997;87:1271.

Kurz A, Go JC, Sessler DI. Alfentanil slightly increases the sweating threshold and markedly reduces the vasoconstriction and shivering thresholds. Anesthesiology. 1995;83:293.

Drenger B, Magora F. Urodynamic studies after intrathecal fentanyl and buprenorphine in the dog. Anesth Analg. 1989;69:348.

Aantaa RE, Kanto JH, Scheinin M. Dexmedetomidine premedication for minor gynecologic surgery. Anesth Analg. 1990;70:407-413.

Porce LR, Guo TZ, Kingery WS. The analgesic potency of dexmedetomidine is enhanced after nerve injury: A possible role for peripheral a2-adrenoceptors. Anesth Analg. 1998;87:941-948.

Nociti JR. Agonistas a2-adrenérgicos: perspectiva atual. Rev Bras Anestesiol. 2001;51:271-272.

Hall JE, Uhrich TD, Ebert TJ. The sedative analgesic and cognitive effects of clonidine infusions in humans. Br J Anaesth. 2001;86:5-11.

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