Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942003000200007
Brazilian Journal of Anesthesiology
Scientific Article

Dexmedetomidina associada a propofol em sedação durante anestesia local para cirurgia plástica

Dexmedetomidine/propofol association for plastic surgery sedation during local anesthesia

José Roberto Nociti; Paulo Sérgio Mateus Serzedo; Eduardo Barbin Zuccolotto; Fabiana Sebben; Raul F. Gonzales

http://dx.doi.org/10.1590/S0034-70942003000200007 Braz J Anesthesiol, vol.53, n2, p.198-208, 2003
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Resumo

JUSTIFICATIVA E OBJETIVOS: A dexmedetomidina é um novo agonista alfa2-adrenérgico com propriedades potencialmente úteis em anestesia. Este estudo comparativo tem por finalidade observar os efeitos da dexmedetomidina sobre o consumo de propofol e a evolução dos parâmetros cardiovasculares e respiratórios, quando incluída em técnica de sedação durante anestesia local em cirurgia plástica. MÉTODO: Participaram do estudo 40 pacientes do sexo feminino com idades entre 16 e 60 anos, estado físico ASA I ou II, submetidas a cirurgias plásticas eletivas sob anestesia local. Foram distribuídas aleatoriamente em dois grupos de vinte: C (controle) e D (dexmedetomidina). Em ambos, a sedação foi obtida com propofol na dose em bolus inicial de 1 mg.kg-1 seguida de infusão contínua em velocidade ajustada para se obter grau de sedação consciente. No grupo D, as pacientes receberam infusão venosa contínua de dexmedetomidina à velocidade de 0,01 µg.kg-1.min-1, concomitante com a de propofol. Foram avaliados: efeito da dexmedetomidina sobre o consumo de propofol; variação dos parâmetros cardiovasculares (PAS, PAD, PAM, FC) e respiratórios (SpO2, P ET CO2); qualidade do controle do sangramento per-operatório e características da recuperação pós-anestésica. RESULTADOS: A velocidade média de infusão de propofol foi menor no grupo D (35,2 ± 5,3 µg.kg-1.min-1) do que no grupo C (72,6 ± 8,5 µg.kg-1.min-1). Os valores médios de PAS, PAD e PAM decresceram em relação ao inicial, a partir dos 30 minutos, no grupo D, mantendo-se a seguir estáveis até o final; no grupo C, aumentaram. A FC manteve-se estável no grupo D e aumentou a partir dos 30 minutos no grupo C. O tempo médio para obedecer ao comando de "abrir os olhos" foi menor no grupo D (6,3 ± 2,5 min) em relação ao C (8,9 ± 2,7 min). O controle do sangramento per-operatório foi superior no grupo D em relação ao C. CONCLUSÕES: O emprego da dexmedetomidina associada ao propofol apresenta as seguintes vantagens: redução do consumo de propofol, estabilidade dos parâmetros cardiovasculares, controle adequado do sangramento per-operatório, ausência de efeito importante sobre a ventilação.

Palavras-chave

ANESTESIA, ANESTESIA, CIRURGIA, HIPNÓTICOS, HIPNÓTICOS

Abstract

BACKGROUND AND OBJECTIVES: Dexmedetomidine is a new alpha2-adrenergic receptor agonist with potentially useful characteristics for anesthesia. This comparative study aimed at evaluating the effects of dexmedetomidine on propofol requirements and cardiovascular/respiratory stability during plastic surgery sedation under local anesthesia. METHODS: Participated in this study 40 female patients aged 16 to 60 years, physical status ASA I or II, scheduled for elective face, nose and breast plastic surgeries under local anesthesia. Patients were randomly allocated into two groups of twenty patients: C (control) and D (dexmedetomidine). Sedation was achieved in both groups with 1 mg.kg-1 bolus propofol followed by continuous infusion at an adjusted rate to provide conscious sedation. Group D patients received continuous intravenous dexmedetomidine at a rate of 0.01 µg.kg-1.min-1, concomitant with propofol infusion. The following were evaluated: effect of dexmedetomidine on propofol requirements; cardiovascular (SBP, DBP, MBP, HR) and respiratory (SpO2, P ET CO2) parameters; quality of perioperative bleeding control and postanesthetic recovery features. RESULTS: Mean propofol infusion rate was lower in group D (35.2 ± 5.3 µg.kg-1.min-1) as compared to group C (72.6 ± 8.5 µg.kg-1.min-1). Mean SBP, DBP, MBP values have decreased as from 30 min in group D, remaining stable until procedure completion, while in Group C they have increased. HR remained stable in group D where as increased as from 30 min in group C. Mean time to open eyes under command was lower in group D (6.3 ± 2.5 min) as compared to group C (8.9 ± 2.7 min). Perioperative bleeding control was better in group D as compared to group C. CONCLUSIONS: Dexmedetomidine/propofol association for sedation is safe and has the following advantages: decrease in propofol requirements, cardiovascular stability, good perioperative bleeding control, lack of significant effects on ventilation.

Keywords

ANESTHESIA, ANESTHESIA, HYPNOTICS, HYPNOTICS, SURGERY

Referencias

Schwarz S, Bergfeld D, Sommer B. Pharmacology. Tumescent Local Anesthesia. 2001:14-27.

Nocite JR. Hipotensão induzida ou anestesia hipotensiva?. Rev Bras Anestesiol. 1988;38:391-392.

Thompson GE, Miller RD, Stevens WC. Hypotensive anesthesia for total hip arthroplasty: a study of blood loss and organ function (brain, heart, liver, and kidney). Anesthesiology. 1978;48:91-96.

Kamibayashi T, Maze M. Clinical uses of alpha-2 adrenergic agonists. Anesthesiology. 2000;93:1345-1349.

Buttermann AE, Maze M. Alpha-2 adrenergic agonists in Anesthesiology. Semin Anesthesia. 1996;15:27-40.

Hayashi Y, Maze M. Alpha-2 adrenoreceptor agonists and anaesthesia. Br J Anaesth. 1993;71:108-118.

Kamibayashi T, Hayashi Y, Sumikawa K. A role of vagus nerve in antiarrhythmic effects of doxazosin and dexmedetomidine on halothane-epinephrine arrhythmia’s. Anesthesiology. 1995;83:992-999.

Hayashi Y, Sumikawa K, Maze M. Dexmedetomidine prevents epinephrine-induced arrhythmia’s through stimulation of central alpha-2 adrenoceptors in halothane-anesthetized dogs. Anesthesiology. 1991;75:113-117.

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

Epstein BS. Role of the Anesthesiologist in Analgesia-Sedation: How, When, and Where?. Refresher Courses in Anesthesiology. 1997;25:45-54.

Jenkins MT, Giesecke AH. Balanced Salt Solutions in Clinical Anesthesia. Refresher Courses in Anesthesiology. 1974;2:107-116.

Shelly MP. Dexmedetomidine: a real innovation or more of the same?. Br J Anaesth. 2001;87:677-678.

Venn RM, Bradshaw CJ, Spencer R. Preliminary UK experience of dexmedetomidine, a novel agent for postoperative sedation in the intensive care unit. Anaesthesia. 1999;54:1136-1142.

Venn RM, Grounds RM. Comparison between dexmedetomidine and propofol for sedation in the intensive care unit patient and clinician perceptions. Br J Anaesth. 2001;87:684-690.

Khan ZP, Munday IT, Jones RM. Effects of dexmedetomidine on isoflurane requirements in healthy volunteers: 1. Pharmacodynamic and pharmacokinetic interactions. Br J Anaesth. 1999;83:372-380.

Nunes RR, Cavalcante SL. Influência da dexmedetomidina na concentração expirada do sevoflurano: Avaliação pelo índice bispectral, taxa de supressão e análise espectral da potência do eletroencefalograma. Rev Bras Anestesiol. 2002;52:133-145.

Dutta S, Karol MD, Cohen T. Effect of dexmedetomidine on propofol requirements in healthy subjects. J Pharm Sci. 2001;90:172-181.

Schwarz S, Rapprich S. Toxicology. Tumescent Local Anesthesia. 2001:28-34.

Vieira JL, Vanetti LFA. Hipotensão arterial induzida durante cirurgia: fisiologia, técnica, riscos. Rev Bras Anestesiol. 1982;32:185-206.

Talke P, Jain U, Leung J. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery. Anesthesiology. 1995;82:620-633.

Aho M, Erkola O, Kallio A. Dexmedetomidine infusion for maintenance of anesthesia in patients undergoing abdominal hysterectomy. Anesth Analg. 1992;75:940-946.

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

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

Venn RM, Hell J, Grounds RM. Respiratory effects of dexmedetomidine in the surgical patient requiring intensive care. Crit Care. 2000;4:302-308.

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