Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942005000100003
Brazilian Journal of Anesthesiology
Scientific Article

Eficácia analgésica da dexmedetomidina comparada ao sufentanil em cirurgias intraperitoneais: estudo comparativo

Analgesic efficacy of dexmedetomidine as compared to sufentanil in intraperitoneal surgeries: comparative study

Marco Aurélio Marangoni; Yara Marcondes Machado Castiglia; Tiago Pechutti Medeiros

http://dx.doi.org/10.1590/S0034-70942005000100003 Braz J Anesthesiol, vol.55, n1, p.19-27, 2005
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Resumo

JUSTIFICATIVA E OBJETIVOS: A dexmedetomidina, agonista alfa2-adrenérgico com especificidade alfa1:alfa2 1:1620, não determina depressão respiratória, sendo utilizada no intra-operatório como sedativo e analgésico. Esse fármaco tem sido empregado com os opióides em anestesia de procedimentos com elevado estímulo doloroso, como os abdominais intraperitoneais, não havendo referências sobre seu uso como analgésico único. Comparou-se a dexmedetomidina ao sufentanil em procedimentos intraperitoneais, de pacientes com mais de 60 anos de idade. MÉTODO: Foram estudados 41 pacientes divididos aleatoriamente em dois grupos: GS (n = 21), que recebeu sufentanil, e GD (n = 20), dexmedetomidina, ambos na indução e manutenção da anestesia. Os pacientes receberam etomidato (GS e GD) com midazolam (GD) na indução, isoflurano e óxido nitroso na manutenção da anestesia. Foram avaliados os atributos hemodinâmicos (pressão arterial média e freqüência cardíaca), tempos de despertar e de extubação ao final da anestesia, locais onde os pacientes foram extubados - sala de operação (SO) ou sala de recuperação pós-anestésica (SRPA), tempo de permanência na SRPA, necessidade de analgesia suplementar e antiemético na SRPA, complicações apresentadas na SO e SRPA, índice de Aldrete-Kroulik na alta da SRPA e a necessidade de máscara de oxigênio na alta da SRPA. RESULTADOS: Não houve diferença quanto à estabilidade hemodinâmica e GD apresentou menor tempo de permanência na SRPA e menor necessidade de máscara de oxigênio na alta da SRPA. CONCLUSÕES: A dexmedetomidina pode ser utilizada como analgésico isolado em operações intraperitoneais em pacientes com mais de 60 anos, determinando estabilidade hemodinâmica semelhante à do sufentanil, com melhores características de recuperação.

Palavras-chave

ANALGÉSICOS, ANALGÉSICOS, ANESTESIA, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Dexmedetomidine, alpha2-adrenergic agonist with alpha1:alpha2 specificity of 1:1620, does not promote respiratory depression and is intraoperatively used for sedation and analgesia. It has been used associated to opioids in anesthesia for procedures with high painful stimulation, such as intraperitoneal surgeries, and there are no references to its use as single agent. Dexmedetomidine was compared to sufentanil during intraperitoneal procedures in patients above 60 years of age. METHODS: Participated in this study 41 patients randomly distributed in two groups: GS (n = 21), receiving sufentanil, and GD (n = 20) receiving dexmedetomidine for anesthetic induction and maintenance. Patients were given etomidate (GS and GD) with midazolam (GD) for induction and isoflurane and nitrous oxide for maintenance. Hemodynamic attributes (mean blood pressure and heart rate), emergence and extubation times, extubation site (OR or PACU), PACU stay, need for additional analgesia and antiemetics in PACU, OR and PACU complications, Aldrete-Kroulik index at PACU discharge and the need for oxygen mask at PACU discharge were evaluated. RESULTS: There were no differences in hemodynamic stability. GD group has remained for a shorter time in PACU with lower need for oxygen mask at PACU discharge. CONCLUSIONS: Dexmedetomidine may be used as single analgesic for intraperitoneal procedures in patients above 60 years of age, promoting hemodynamic stability similar to sufentanil, with better recovery profile.

Keywords

ANALGESICS, ANALGESICS, ANESTHESIA, ANESTHETIC TECHNIQUES

References

Virtanen R, Savola JM, Saano V. Characterization of selectivity, specificity and potency of medetomidine as an alpha2-adrenoceptor agonist. Eur J Pharmacol. 1988;150:9-14.

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

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

Bernard JM, Hommeril JL, Passuti N. Postoperative analgesia by intravenous clonidine. Anesthesiology. 1991;75:577-582.

Jalonen J, Hynynen M, Kuitunen A. Dexmedetomidine as an anesthetic adjunct in coronary artery bypass grafting. Anesthesiology. 1997;86:331-345.

Bhana N, Goa KL, McClellan KJ. Dexmedetomidine. Drugs. 2000;59:263-268.

Talke P, Li J, Jain U. Effects of perioperative dexmedetomidine infusion in patients undergoing vascular surgery: The Study of Perioperative Ischemia Research Group. Anesthesiology. 1995;82:620-633.

Aantaa R. Assessment of the sedative effects of dexmedetomidine, an alpha2adrenoceptor agonist, with analysis of saccadic eye movements. Pharmacol Toxicol. 1991;68:394-398.

Lawrence CJ, Prinzen FW, De Lange S. The effect of dexmedetomidine on the balance of myocardial energy requirement and oxygen supply and demand. Anesth Analg. 1996;82:544-550.

Bloor BC, Ward DS, Belleville JP. Effects of intravenous dexmedetomidine in humans II: Hemodynamics 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.

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

Bailey PI, Egan TD, Stanley TH. Intravenous Opioid Anesthetics. Anesthesia. 2000:273-376.

Jaakola ML, Ali-Melkkila T, Kanto J. Dexmedetomidine reduces intraocular pressure, intubation responses, and anaesthetic requirements in patients undergoing ophthalmic surgery. Br J Anaesth. 1992;68:570-575.

Aantaa R, Kallio A, Virtanen R. Dexmedetomidine, a novel alpha2-adrenergic agonist: A review of its pharmacodynamic characteristics. Drugs Future. 1993;18:49-56.

Erkola O, Korttila K, Aho M. Comparison of intramuscular dexmedetomidine and midazolam premedication for elective abdominal hysterectomy. Anesth Analg. 1994;79:646-653.

Curtis FG, Castiglia YMM, Stolf AA. Dexmedetomidine and sufentanil as intraoperative analgesics: Comparative study. Rev Bras Anestesiol. 2002;52:525-534.

Aantaa A, Jaakola ML, Kallio A. Reduction of the MAC of isoflurane by dexmedetomidine. Anesthesiology. 1997;86:1055-1060.

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