Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942004000200005
Brazilian Journal of Anesthesiology
Scientific Article

Remifentanil versus dexmedetomidina como coadjuvantes de técnica anestésica padronizada em pacientes com obesidade mórbida

Remifentanil versus dexmedetomidine as coadjutants of standardized anesthetic technique in morbidly obese patients

Eliana Cristina Murari Sudré; Maria do Carmo Salvador; Giuseppina Elena Bruno; Dalton Valentim Vassallo; Gabriela Rocha Lauretti; Gilberto Neves Sudré Filho

http://dx.doi.org/10.1590/S0034-70942004000200005 Braz J Anesthesiol, vol.54, n2, p.178-189, 2004
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Resumo

JUSTIFICATIVA E OBJETIVOS: Comparou-se a ação de duas drogas coadjuvantes da anestesia, remifentanil e dexmedetomidina, na recuperação anestésica e na evolução do pH e da PaCO2, em pacientes com obesidade mórbida que foram submetidos à cirurgia de Capella. MÉTODO: O estudo foi aleatório, prospectivo e duplamente encoberto. Noventa e dois pacientes foram designados a um de dois grupos e submetidos à técnica anestésica (geral/peridural) padronizada. O grupo Remifentanil (Grupo R) e o da Dexmedetomidina (Grupo D) receberam infusão contínua por via venosa destas drogas (0,1 µg.kg-1.min-1 e 0,5 µg.kg-1.h-1 peso ideal mais 30% para ambas) logo após a intubação traqueal. Os pacientes foram monitorizados com pressão arterial média invasiva, oximetria de pulso, EEG bispectral (BIS), capnografia, estimulador de nervo periférico e ECG. Foram avaliados: 1) diferentes tempos de recuperação anestésica (abertura dos olhos, reinicio da respiração espontânea, tempo de extubação traqueal, tempo para de alta da sala de recuperação pós-anestésica e hospitalar), 2) a evolução da gasometria arterial, e 3) analgesia pós-operatória. RESULTADOS: Oitenta e oito pacientes foram avaliados. Os pacientes do grupo R apresentaram abertura ocular precoce (9,49 ± 5,61 min versus 18,25 ± 10,24 min, p < 0,0001), menor tempo para reiniciar a ventilação espontânea (9,78 ± 5,80 min versus 16,58 ± 6,07 min, p < 0,0001), e menor tempo para a extubação traqueal (17,93 ± 10,39 min versus 27,53 ± 13,39 min, p < 0,0001). Não houve diferença quanto ao tempo para alta anestésica (105,18 ± 50,82 min versus 118,69 ± 56,18 min) e para alta hospitalar (51,13 ± 6,37 horas versus 52,50 ± 7,09 horas). Os dois grupos apresentaram diminuição dos valores de pH e da PaO2 imediatamente após a extubação traqueal comparados com valores pré-operatórios, e que se manteve até a alta da SRPA. O grupo D apresentou valores maiores de PaCO2 após a extubação traqueal, comparados com valores pré-operatórios no mesmo grupo (p < 0,05), divergente do Grupo R; 41% dos pacientes do Grupo R e 60% do Grupo D (p < 0,02) requisitaram medicação analgésica de resgate no primeiro dia de pós-operatório. CONCLUSÕES: Na população avaliada, a associação de remifentanil em técnica anestésica padronizada resultou em recuperação anestésica mais rápida, manutenção dos valores de PaCO2 durante o período pós-operatório imediato e menor consumo de analgésicos de resgate no período pós-operatório, quando comparada à dexmedetomidina.

Palavras-chave

ANALGÉSICOS, ANALGÉSICOS, DOENÇAS, DROGAS, DROGAS

Abstract

BACKGROUND AND OBJECTIVES: Two coadjuvant anesthetic drugs - remifentanil and dexmedetomidine - were compared in terms of anesthetic recovery, arterial pH and PaCO2 evolution, in morbidly obese patients submitted to Capella's surgery. METHODS: Participated in this prospective, randomized and double blind study 92 patients divided in two groups and submitted to standardized anesthetic technique (general/epidural). Remifentanil Group (Group R) and Dexmedetomidine Group (Group D) received continuous intravenous infusion of these drugs (0.1 µg.kg-1.min-1 and 0.5 µg.kg-1.h-1, ideal body weight plus 30% for both) immediately after tracheal intubation. Monitoring consisted of invasive mean blood pressure, pulse oximetry, BIS EEG, capnography, peripheral nerve stimulator and EKG. The following parameters were evaluated: 1) different anesthetic recovery times (eye opening, return to spontaneous ventilation, tracheal extubation time, time for post anesthetic recovery unit and hospital discharge); 2) arterial blood gas analysis evolution; and 3) postoperative analgesia. RESULTS: Evaluation was possible in 88 patients. Patients group R had earlier eye opening (9.49 ± 5.61 min versus 18.25 ± 10.24 min, p < 0.0001), faster return to spontaneous ventilation (9.78 ± 5.80 min versus 16.58 ± 6.07 min, p < 0.0001), and earlier tracheal extubation (17.93 ± 10.39 min versus 27.53 ± 13.39 min, p < 0.0001). There were no differences in times for post-anesthetic recovery unit (105.18 ± 50.82 min versus 118.69 ± 56.18 min) and hospital (51.13 ± 6.37 hours versus 52.50 ± 7.09 hours) discharge. Both groups showed arterial pH and PaO2 decrease immediately after tracheal extubation as compared to preoperative values, still present at PACU discharge. Group D patients showed higher arterial PaCO2 after tracheal extubation, as compared to preoperative values in the same group (p < 0.05), and opposed to Group R. 41% of Group R and 60% Group D patients (p < 0.02) required rescue analgesia during the first postoperative day. CONCLUSIONS: In the studied population, the association of remifentanil to standardized anesthetic technique has resulted in faster anesthetic recovery, stability of preoperative arterial PaCO2 values during the immediate postoperative period and lower postoperative rescue analgesics consumption, as compared to dexmedetomidine.

Keywords

ANALGESICS, ANALGESICS, DISEASES, DRUGS, DRUGS

References

Schroder T, Nolte M, Kox WJ. Anesthesia in extreme obesity. Hertz. 2001;26:222-228.

Auler Jr JOC, Miyoshi E, Fernandes CR. The effects of abdominal opening on respiratory mechanics during general anesthesia in normal and morbidly obese patients: a comparative study. Anesth Analg. 2002;94:741-748.

Torres LM, Calderon E, Velazquez A. Remifentanil: Indications in anesthesia. Rev Esp Anestesiol Reanim. 1999;46:75-80.

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

Drummond G. Dexmedetomidine may be effective, but is it safe?. Br J Anaesth. 2002;88:454-455.

Capella RF, Capella JF, Mandec H. Vertical banded gastroplasty-gastric bypass: preliminary report. Obes Surg. 1991;1:389-395.

Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br J Anaesth. 2000;85:91-108.

Casati A, Albertin A, Danelli G. Implementing sevoflurane anesthesia with small doses opioid for upper abdominal surgery: Postoperative respiratory function after either remifentanil or fentanyl. Minerva Anestesiol. 2001;67:621-628.

Torri G, Casati A, Comotti L et al. Wash-in and wash-out curves of sevoflurane and isoflurane in morbidly obese patients. Minerva Anestesiol. 2002;68:523-527.

Rigg JR, Jamrozik K, Myles PS. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet. 2002;359:1276-1282.

Drover DR, Lemmens HJ. Population pharmacodynamics and pharmacokinetics of remifentanil as a supplement to nitrous oxide anesthesia for elective abdominal surgery. Anesthesiology. 1998;89:869-877.

Egan TD, Huizinga B, Gupta SK. Remifentanil pharmacokinetics in obese versus lean patients. Anesthesiology. 1998;89:562-573.

Masuda T, Yamada H, Takada K. Bispectral index monitoring is useful to reduce total amount of propofol and to obtain immediate recovery after propofol anesthesia. Masui. 2002;51:394-399.

Zarate E, Latham P, White PF. Fast-track cardiac anesthesia: use of remifentanil combined with intrathecal morphine as an alternative to sufentanil during desflurane anesthesia. Anesth Analg. 2000;91:283-287.

Eichenberger A, Proietti S, Wicky S. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg. 2002;95:1788-1792.

Taylor RR, Kelly TM, Elliott CG. Hypoxemia after gastric bypass surgery for morbid obesity. Arch Surg. 1985;120:1298-1302.

Bailey PL, Sperry RJ, Johnson GK. Respiratory effects of clonidine alone and combined with morphine in humans. Anesthesiology. 1991;74:43-48.

Melero A, Vallés J, Vila P. Recuperación anestésica, intercambio gaseoso y función hepática y renal postoperatorios en pacientes con obesidad mórbida sometidos a cirugía bariátrica: comparación de los efectos del halotano, isoflurano y fentanil. Rev Esp Anestesiol Reanim. 1993;40:268-272.

Alexander R, Booth J, Olufolabi AJ. Comparison of remifentanil with alfentanil or suxamethonium following propofol anaesthesia for tracheal intubation. Anaesthesia. 1999;54:1032-1036.

Atkins M, White J, Ahmed K. Day surgery and body mass index: results of a national survey. Anaesthesia. 2002;57:180-182.

Blanco Engert R, Gascon M, Weiner R. Video-laparoscopic placement of adjustable gastric banding (lap-band) in the treatment of morbid obesity: Preliminary results after 407 interventions. Gastroenterol Hepatol. 2001;24:381-386.

Juvin P, Vadam C, Malek L. Postoperatory recovery after desflurane, propofol, or isoflurane anesthesia among morbidly obese patients: a prospective, randomized study. Anesth Analg. 2000;91:714-719.

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