Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942003000200003
Brazilian Journal of Anesthesiology
Scientific Article

Anestesia peridural contínua com ropivacaína a 0,2% associada a anestesia geral para cirurgia do abdômen superior em crianças

Continuous epidural anesthesia with 0.2% ropivacaine associated to general anesthesia for upper abdominal surgery in children

Jyrson Guilherme Klamt; Luis Vicente Garcia; Renato Mestriner Stocche; Marlene Paulino dos Reis

http://dx.doi.org/10.1590/S0034-70942003000200003 Braz J Anesthesiol, vol.53, n2, p.160-168, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: Técnicas anestésicas têm sido empregadas em pacientes pediátricos para vários tipos de cirurgias, apresentando entre outras vantagens, a analgesia pós-operatória. O objetivo deste estudo foi avaliar o ritmo de infusão de propofol e a recuperação pós-anestésica de crianças submetidas à cirurgia abdominal alta sob anestesia peridural torácica com ropivacaína a 0,2%, associada à anestesia geral com propofol ou propofol mais sufentanil. MÉTODO: Vinte e seis crianças ASA I, II e III, com idades entre 0 e 4 anos, submetidas à cirurgia abdominal alta foram selecionadas para anestesia peridural torácica (T7-T8) com ropivacaína a 0,2% (1,5 ml.kg-1). Foram divididas aleatoriamente em dois grupos: Propofol (infusão de propofol) e Sufentanil (infusão de propofol mais sufentanil 1 µg.kg-1). Os ritmos de infusões de propofol foram de 20 e 10 mg.kg-1.h-1 nos grupos Propofol e Sufentanil, respectivamente, ajustadas de modo a manter a pressão arterial cerca de 20% dos valores pré-indução e interrompidas 10 a 15 minutos antes do final estimado da cirurgia. A recuperação pós-anestésica foi avaliada através de uma escala modificada de Aldrete-Kroulik e a sedação avaliada através de uma escala de 5 pontos. RESULTADOS: Duas crianças de cada grupo foram excluídas por problemas técnicos. O ritmo de infusão foi significativamente menor no grupo Sufentanil em relação ao grupo Propofol durante 100 minutos após o início da cirurgia. Os tempos para extubação e transferência para a sala de recuperação pós-anestésica (SRPA) foram significativamente menores no grupo Propofol, porém a intensidade e a duração da sedação foram maiores nesse grupo em relação ao grupo Sufentanil. Os escores de recuperação foram similares nos dois grupos. Após 3 horas na SRPA, todos pacientes haviam atingido os critérios para transferência para as enfermarias. Hipotensão arterial transitória foi observada em 2 pacientes do grupo Sufentanil. CONCLUSÕES: A combinação da anestesia peridural torácica contínua com ropivacaína a 0,2% (1,5 ml.kg-1) associada à infusão de propofol promove anestesia efetiva e segura para cirurgias abdominais altas em crianças. O ritmo de infusão de propofol e o tempo de sedação foram reduzidos com a adição de sufentanil.

Palavras-chave

ANESTESIA, ANESTÉSICOS, ANESTÉSICOS, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Several anesthetic techniques have been proposed for different pediatric surgeries to promote postoperative analgesia, among other advantages. This study aimed at evaluating propofol infusion rate and postanesthetic recovery of children submitted to upper abdominal surgeries under epidural anesthesia with 0.2% ropivacaine associated to general anesthesia with propofol or propofol plus sufentanil. METHODS: Participated in this study 26 children physical status ASA I, II and III, aged 0 to 4 years, were scheduled to upper abdominal surgeries under thoracic epidural anesthesia (T7-T8) with 0.2% ropivacaine (1.5 ml.kg-1). They were randomly distributed in two groups: Propofol (propofol infusion) and Sufentanil (propofol infusion plus 1 µg.kg-1 sufentanil). Propofol infusion rates were 20 and 10 mg.kg-1.h-1 for the Propofol and Sufentanil groups, respectively, adjusted to maintain blood pressure in approximately 20% of baseline values and withdrawn 10 to 15 minutes before estimated surgery completion. Postanesthetic recovery was evaluated by a modified Aldrete-Kroulik scale and sedation was evaluated by a 5 grade score. RESULTS: Techical difficulties excluded two children of each group. Infusion rate was significantly slower in the Sufentanil group as compared to the Propofol group during 100 minutes after beginning of surgery. Time for extubation and referral to post-anesthetic recovery unit (PACU) was significantly shorter for the Propofol group, however sedation intensity and duration were longer in this group as compared to Sufentanil group. Recovery scores were similar for both groups. Three hours after PACU admission all patients were meeting criteria to be transferred to the ward. Transient arterial hypotension was observed in 2 Sufentanil group patients. CONCLUSIONS: Continuous thoracic epidural anesthesia with 0.2% ropivacaine (1.5 mg.kg-1) associated to propofol infusion provides effective and safe anesthesia for upper pediatric abdominal surgeries. Propofol infusion rate and sedation duration were decreased with the association of sufentanil.

Keywords

ANESTHESIA, ANESTHETICS, ANESTHETICS, ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES

References

Peterson KL, De Campli WM, Pike NA. A report of two hundred twenty cases of regional anesthesia in pediatric cardiac surgery. Anesth Analg. 2000;90:1014-1019.

Hammer GR, Neos K, Macario A. A retrospective examination of regional plus general anesthesia in children undergoing heart surgery. Anesth Analg. 2000;90:1020-1024.

Knidsen K, Becman-Suurkula M, Blomberg S. Central and cardiovascular effects during infusion of ropivacaine and placebo. Br J Anaesth. 1997;78:507-514.

Conceição MJ, Coelho L, Khalil M. Ropivacaine 0.25% compared with bupivacaine 0.25% by caudal route. Paed Anaesth. 1999;9:229-233.

Ivani G, Lampugnani E, De Negri P. Ropivacaine vs bupivacaine in major surgery in infants. Can J Anaesth. 1999;46:467-469.

Hickey R, Blanchard J, Hoffman J. Plasma concentrations of ropivacaine given with or without epinephrine for brachial plexus block. Can J Anaesth. 1990;37:878-882.

Konig H, Krenn CG, Glaser C. A dose-response of caudal ropivacaine in children. Anesthesiology. 1999;90:1339-1344.

Hannallah RS, Baker SB, Casey W. Propofol dose and induction characteristics in unpremedicated children. Anesthesiology. 1991;74:217:219.

Aun CST, Sung RYT, O’Meara ME. Cardiovascular effects of i.v. induction in children: comparison between propofol and thiopentone. Br J Anaesth. 1993;70:647-653.

Williams GL, Jones TK, Hanson KA. The hemodynamic effects of propofol in children with congenital heart disease. Anesth Analg. 1999;89:1411-1461.

Westren P. Induction dose of propofol in infants 1-6 months of age and children 10-16 years of age. Anesthesiology. 1991;74:455-458.

Browne BL, Prys-Roberts C, Wolf AR. Propofol and alfentanil in children, infusion technique and dose requirement for total i.v. anaesthesia. Br J Anaesth. 1992;69:570-576.

Doyle D, McFadzean W, Morton NS. IV anaesthesia with propofol using target-controlled system: comparison with inhalation anaesthesia for general surgical procedures in children. Br J Anaesth. 1993;70:542-545.

Braithwaite P, Dowson S, Entes AH. Propofol and fentanyl infusions for cardiac surgery in children. J Cardiothor Vasc Anesth. 1990;4:126-131.

Kazama T, Ieda K, Morita K. Reduction by fentanyl of the Cp50 of propofol and hemodynamic responses to various noxious stimuli. Anesthesiology. 1997;87:213-227.

Ates Y, Ünal N, Cuhruk H. Postoperative analgesia in children using a preemptive retrobulbar block and local anesthetic infiltration in strabismus surgery. Reg Anesth Pain Med. 1998;23:569-574.

Yaster M, Billet C. Intravenous Patient Controlled Analgesia. Pediatric Pain Management and Sedation Handbook. 1997:89-111.

Mc Farlan CS, Anderson B, Short T. The use of propofol infusion in paediatric anaesthesia: a practical guide. Paed Anaesth. 1999;9:209-216.

Hertzog GH, Campbell JK, Dalton H. Propofol anesthesia for invasive procedures in ambulatory and hospitalized children: experience in the paediatric intensive care unit. Paediatrics. 1999:103:E30.

Picard V, Dumont L, Pellegrine M. Quality of recovery in children: sevoflurane versus propofol. Acta Anaesthesiol Scand. 2000;44:307-310.

Yaster M, Maxwell LG. Pediatric regional anesthesia. Anesthesiology. 1989;70:324-338.

Rowney DA, Doyle E. Epidural and subarachnoid blockade in children. Anaesthesia. 1998;53:980-1001.

Kohane DS, Sankar WN, Shubina M. Sciatic nerve blockade in infant, adolescent, and adult rats. Anesthesiology. 1998;89:1199-1208.

Dalens BJ, Mazut JX. Adverse effects of regional anesthesia in children. Drug Saf. 1998;19:251-268.

Berde CB. Toxicity of local anesthetic in infants and children. J Pediatr. 1993;22:14-20.

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