Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942003000100003
Brazilian Journal of Anesthesiology
Scientific Article

Avaliação do estado ácido-básico materno com o uso de sufentanil por via subaracnóidea em diferentes doses para cesarianas e suas repercussões sobre os recém-nascidos

Evaluation of maternal acid-base status after different doses of spinal sufentanil for cesarean section and its effects on the neonates

Luís Fernando Lima Castro; Maurício Marsaioli Serafim; Carlos Alberto Figueiredo Côrtes; Necime Lopes da Silva Neto; Fabrízio Oliveira Vasconcellos; Amaury Sanchez Oliveira

http://dx.doi.org/10.1590/S0034-70942003000100003 Braz J Anesthesiol, vol.53, n1, p.17-24, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: O sufentanil subaracnóideo em obstetrícia promove alívio imediato da dor, melhor qualidade da anestesia e analgesia pós-operatória mais prolongada, tendo como efeito colateral mais grave a depressão respiratória. Objetivou-se neste estudo avaliar o estado ácido-básico materno com o uso de sufentanil subaracnóideo em diferentes doses, associado à bupivacaína hiperbárica, para cesarianas e suas repercussões sobre os recém-nascidos. MÉTODO: Foram avaliadas 40 gestantes a termo, estado físico ASA I, com idades entre 17 e 35 anos, submetidas à cesariana eletiva sob raquianestesia e divididas em 2 grupos eqüitativos: no grupo I, receberam 12 mg de bupivacaína a 0,5% hiperbárica associados a 2,5 µg de sufentanil e no grupo II, receberam 12 mg de bupivacaína a 0,5% hiperbárica associados a 5 µg de sufentanil. Foram avaliados: estado ácido-básico materno através de gasometria arterial antes da realização da anestesia e após o nascimento do concepto, SpO2, alterações hemodinâmicas, vitalidade dos recém-nascidos através do índice de Apgar e gasometria do cordão umbilical e presença de efeitos colaterais. RESULTADOS: Os grupos mostraram-se homogêneos nos parâmetros avaliados, observando-se discreta acidose metabólica materna compensada em ambos os grupos tanto antes da realização da anestesia como logo após o nascimento do concepto; porém, sem repercussões clínicas. Os recém-nascidos apresentaram boa vitalidade e gasometrias compatíveis com a normalidade. CONCLUSÕES: A associação de bupivacaína hiperbárica a 0,5% a pequenas doses de sufentanil subaracnóideo em cesarianas mostrou ser técnica segura ao binômio materno-fetal, preservando seu estado hemodinâmico e ácido-básico.

Palavras-chave

ANALGESIA, ANALGESIA, ANALGÉSICOS, ANALGÉSICOS, ANESTÉSICOS, ANESTÉSICOS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Spinal sufentanil in obstetric anesthesia promotes immediate pain relief, improves anesthesia quality and prolongs postoperative analgesia, its major side effect being respiratory depression. This study aimed at evaluating maternal acid-base status after different doses of spinal sufentanil associated to hyperbaric bupivacaine for cesarean section, and its effects on neonates' vitality. METHODS: Participated in this study 40 full term pregnant women, physical status I (ASA), aged 17 to 35 years, who were submitted to elective cesarean section under spinal anesthesia. Patients were distributed into two equal groups: Group I received 12 mg of hyperbaric 0.5% bupivacaine associated to 2.5 µg sufentanil; Group II received 12 mg of hyperbaric 0.5% bupivacaine associated to 5 µg sufentanil. The following parameters were evaluated: maternal acid-base status through arterial blood gas analysis before anesthesia and after birth, SpO2, hemodynamic changes, neonates' vitality evaluated through Apgar Index and umbilical cord blood gas analysis, in addition to the incidence of side effects. RESULTS: There were no differences between groups in all parameters evaluated, with a mild maternal metabolic acidosis compensated in both groups both before anesthesia and soon after birth, however without clinical repercussions. Neonates showed good vitality and normal blood gas analysis. CONCLUSIONS: The association of spinal hyperbaric 0.5% bupivacaine to low sufentanil doses has shown to be safe to both mother and neonate, preserving their hemodynamic and acid-base status.

Keywords

ANALGESIA, ANALGESIA, ANALGESICS, ANALGESICS, ANESTHETICS, ANESTHETICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES

References

Wang JK, Nauss LA, Thomas SE. Pain relief by intrathecally applied morphine in humans. Anesthesiology. 1979;50:149-151.

Palmer MG. Early respiratory depression following intrathecal fentanyl-morphine combination. Anesthesiology. 1991;74:1153-1155.

Milon D, Lawenac G, Moury D. Analgésie peridurale au conrade Travail: comparaison de trois associations fentanyl- bupivacaine et la bupivacaine seule. Ann Fr Anesth Reanim. 1986;5:18-23.

Norris MC, Grieco WM, Borkowski M. Complications of labor analgesia: epidural versus combined spinal epidural techniques. Anesth Analg. 1994;79:529-537.

Hamilton CL, Cohen SE. High sensory block after sufentanil intrathecal for labor analgesia. Anesthesiology. 1995;83:1118-1121.

Baker MN, Sarna MC. Respiratory arrest after second dose of intrathecal sufentanil. Anesthesiology. 1995;83:231-232.

Feranz F, Norris MC, Leigghtan B. Risk of respiratory arrest after intrathecal sufentanil. Anesth Analg. 1997;85:1088-1090.

James IF, Goldstern A. Sih - directed alkylation of multiple opioid receptors: I: Binding Selectivity. Mol Pharmacol. 1984;25:337-342.

Leysen JE, Gammeren W, Niemegeers CJE. H3 th -sufentanil, a superior ligant for µ-opioids receptors: binding properties and Regional distribution in rat brain and spinal cord. Eur J Pharmacol. 1983;87:209-225.

Donadoni R, Rolly G, Noorduin H. Epidural sufentanil versus intramuscular morphine for postoperative analgesia: a double-blind comparative trial. Anesthesiology. 1987;40:1171-1175.

Benlabed M, Ecoffey J, Levron JC. Analgesia and ventilatory response to CO2 following epidural sufentanil in children. Anesthesiology. 1987;67:948-951.

Van Des Armena D, Verborgh C, Carmen F. Analgesia and cardiorespiratory effects of epidural sufentanil and morphine in humans. Anesth Analg. 1987;66:999-1003.

Verborgh C, Von Der Anwera D, Von Droogenbreck E. Epidural sufentanil for postsurgical pain relief. Eur J Anaesth. 1986;3:313-320.

Klepper ID, Sherrill DL, Beetger CL. Analgesic and respiratory effects of extradural sufentanil in volunteers and the influence of adrenaline as an adjuvant. Br J Anaesth. 1987;59:1147-1156.

Etches RC, Sandles AN, Daley MD. Respiratory depression and spinal opioids. Can J Anaesth. 1989;36:165-185.

Alvarez MAP, Acosta JAG, Godoy MC. Opióides na Raquianestesia. Tratado de Anestesia Raquidiana. 2001:87-89.

Hansdottir V, Hender T, Waestenborghs R. The CSF and plasma pharmacokinetics of sufentanil after intrathecal administration. Anesthesiology. 1991;74:264-269.

Hamilton CC, Colum SF. High sensory block after intrathecal sufentanil for labor analgesia. Anesthesiology. 1995;83:1118-1121.

Greenhalgh CA. Respiratory arrest in a parturient following intrathecal injection of sufentanil and bupivacaine. Anaesthesia. 1996;51:173-175.

Norris MC, Ryan C, Fagel ST. Intrathecal sufentanil increases end-tidal CO2 in laboring women. Anesthesiology. 1997;3A:87.

Hays RL, Palmer CM. Respiratory depression after intrathecal sufentanil during labor. Anesthesiology. 1994;81:511-512.

Baker MN, Sarna MC. Respiratory arrest after second dose of intrathecal sufentanil. Anesthesiology. 1995;83:231-232.

Lu JK, Schafer PG, Pal JF. Intrathecal sufentanil in female volunteers: dose-response respiratory effects. Anesth Analg. 1995;80:287.

Abou WA, Aveline C, Bonnet F. Two additional cases of excessive extension of sensory blockade after intrathecal sufentanil for labor analgesia. International Journal of Obstetric Anesthesia. 2000;9:48-50.

Conklin KA. Maternal Physiologic Consideration during Pregnancy and Delivery. Pain Relief and Anesthesia in Obstetrics. 1996:65.

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