Efeitos hemodinâmicos da oclusão da aorta durante anestesia inalatória com isoflurano e sevoflurano: estudo experimental em cães

Artur Udelsmann; Derli Conceição Munhoz; Álvaro Edmundo Simões Ulhoa Cintra; José Eduardo Tanus dos Santos

doi:10.1590/S0034-70942006000300004

Scientific Article

Efeitos hemodinâmicos da oclusão da aorta durante anestesia inalatória com isoflurano e sevoflurano: estudo experimental em cães

Hemodynamic effects of aortic occlusion during inhalational anesthesia with isoflurane and sevoflurane: experimental study in dogs

Artur Udelsmann; Derli Conceição Munhoz; Álvaro Edmundo Simões Ulhoa Cintra; José Eduardo Tanus dos Santos

http://dx.doi.org/10.1590/S0034-70942006000300004 Braz J Anesthesiol, vol.56, n3, p.239-252, 2006

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Resumo

JUSTIFICATIVA E OBJETIVOS: A supressão do fluxo aórtico e sua posterior liberação em intervenções cirúrgicas da aorta ocasionam importantes distúrbios hemodinâmicos. O objetivo deste estudo foi avaliar essas alterações em cães anestesiados com isoflurano ou sevoflurano. MÉTODO: Foram estudados 41 cães, divididos em dois grupos segundo o anestésico empregado na manutenção com 1 CAM: GI (n = 21) isoflurano; GS (n = 20) sevoflurano. Foi realizada a oclusão aórtica por insuflação de balão intra-arterial infradiafragmático por 30 minutos. Os parâmetros hemodinâmicos foram observados nos momentos M1 (controle), M2 e M3, 15 e 30 minutos após a oclusão aórtica, M4 e M5, 15 e 30 minutos após a desinsuflação do balão. RESULTADOS: Durante a oclusão da aorta, observou-se aumento da pressão arterial média (PAM), da pressão venosa central (PVC), da pressão de artéria pulmonar (PAP), da pressão de capilar pulmonar (PCP) e da resistência vascular sistêmica (RVS) sem aumento da resistência vascular pulmonar (RVP) e do débito cardíaco (DC). O DC manteve-se mais estável com o isoflurano comparado com o sevoflurano, com o qual apresentou diminuição após a oclusão. A freqüência cardíaca teve diminuição inicial seguida de aumento durante a oclusão sendo em GS mais expressiva do que em GI, porém sem diferença significativa entre os grupos. O volume sistólico não teve grandes alterações; o trabalho sistólico dos ventrículos esquerdo e direito aumentou após a oclusão de forma semelhante nos dois grupos. Com a liberação do fluxo PAM, PVC, PAP, PCP e RVS diminuíram, a RVP aumentou nos dois grupos; o trabalho ventricular diminuiu abruptamente. CONCLUSÕES: O estudo demonstrou ser o isoflurano mais bem indicado nessas intervenções cirúrgicas por causar menores alterações hemodinâmicas.

Palavras-chave

ANESTÉSICOS, Geral, ANESTÉSICOS, Geral, ANIMAIS, CIRURGIA, Vascular

Abstract

BACKGROUND AND OBJECTIVES: Aortic flow suppression and release during aortic procedures promote major hemodynamic disorders. This study aimed at evaluating these disorders in dogs anesthetized with isoflurane or sevoflurane. METHODS: This study involved 41 dogs divided in two groups according to the anesthetic agent used for maintenance with 1 MAC: GI (n = 21) isoflurane; GS (n = 20) sevoflurane. Aorta was occluded by intra-arterial infra-diafragmatic cuff inflation for 30 minutes. Hemodynamic parameters were observed in moments M1 (control), M2 and M3, 15 and 30 minutes after aortic occlusion, M4 and M5, 15 and 30 minutes after cuff deflation. RESULTS: During aortic occlusion there has been increased mean blood pressure (MBP), central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP) and systemic vascular resistance (SVR), without increase in pulmonary vascular resistance (PVR) and cardiac output (CO). CO was more stable with isoflurane as compared to sevoflurane where it has decreased after occlusion. Heart rate has initially decreased followed by increase during occlusion, being more expressive in GS as compared to GI, however without statistically significant difference between groups. Systolic volume was not importantly changed; left and right ventricular function have similarly increased after occlusion for both groups. With flow release, MBP, CVP, PAP, PCWP and SVR have decreased, and PVR has increased for both groups; ventricular function has abruptly decreased. CONCLUSIONS: This study has shown that isoflurane is a better indication for such interventions for promoting less hemodynamic changes.

Keywords

ANESTHETICS, General, ANESTHETICS, General, ANIMALS, SURGERY, Vascular

Referencias

Raby KE, Goldman L, Creager MA. Correlation between preoperative ischemia and major cardiac events after peripheral vascular surgery. N Engl J Med. 1989;321:1296-1300.

Rao TL, Jacobs KH, El-Etr AA. Reinfarction following anesthesia in patients with myocardial infarction. Anesthesiology. 1983;59:499-505.

Gelman S. The pathophysiology of aortic cross-clamping and unclamping. Anesthesiology. 1995;82:1026-1060.

Jamieson WR, Janusz MT, Miyagishima RT. Influence of ischemic heart disease on early and late mortality after surgery for peripheral occlusive vascular disease. Circulation. 1982;66(^s2):I92-I97.

Kwitka G, Roseberg JN, Negent M. Thoracic Aortic Disease. Cardiac Anesthesia. 1993.

Roizen MF, Beaupre PN, Alpert RA. Monitoring with two-dimensinal transesophageal echocardiography: Comparison of myocardial function in patients undergoing supraceliac, suprarenal-infraceliac or infrarenal aortic occlusion. J Vasc Surg. 1984;1:300-305.

Amaral RVG, Pereira JCD. Anestesia para Cirurgia Vascular. Anestesiologia. 2001:931-970.

Colson P, Capdevilla X, Barlet H. Effects of halothane and isoflurane on transient renal dysfunction associated with infrarenal aortic cross-clamping. J Cardiothorac Vasc Anesth. 1992;6:295-298.

Sundeman H, Biber B, Henriksson BA. Effects of desflurane on systemic, preportal and renal circulatory responses to infra-renal aortic cross-clamping in the pig. Acta Anaesthesiol Scand. 1996;40:876-882.

Eyraud D, Benmalek F, Teugels K. Does desflurane alter left ventricular function when used to control surgical stimulation during aortic surgery?. Acta Anaesthesiol Scand. 1999;43:737-743.

Brunson DB. Pharmacology of Inhalation Anesthetics. Anesthesia and Analgesia in Laboratory Animals. 1997:29-41.

Shepherd AP, Mailman D, Burks TF. Effects of norepinephrine and sympathetic stimulation on extraction of oxygen and 86Rb in perfused canine small bowel. Circ Res. 1973;33:166-174.

Roizen MF, Ellis JE, Foss JF. Intraoperative Management of the Patient Requiring Supraceliac Aortic Occlusion. Vascular Surgery. 1994:256-278.

Kien ND, White DA, Reitan JA. The influence of adenosine triphosphate on left ventricular function and blood flow distribution during aortic crossclamping in dogs. J Cardiothorac Anesth. 1987;1:114-122.

Quintin L, Bonnet F, Macquin I. Aortic surgery: effect of clonidine on intraoperative catecholaminergic and circulatory stability. Acta Anaesthesiol Scand. 1990;34:132-137.

Vandermeer TJ, Maini BS, Hendershott TH. Evaluation of right ventricular function during aortic operations. Arch Surg. 1993;128:582-585.

Heerdt PM, Gandhi CD, Dickstein ML. Disparity of isoflurane effects on left and right ventricular afterload and hydraulic power generation in swine. Anesth Analg. 1998;87:511-521.

Malan TP, DiNardo JA, Isner RJ. Cardiovascular effects of sevoflurane compared with those of isoflurane in volunteers. Anesthesiology. 1995;83:918-928.

Rooke GA, Ebert T, Muzi M. The hemodynamic and renal effects of sevoflurane and isoflurane in patients with coronary artery disease and chronic hypertension. Sevoflurane Ischemia Study Group. Anesth Analg. 1996;82:1159-1165.

Nielsen VG, Weinbroum A, Tan S. Xanthine oxidoreductase release after descending thoracic aorta occlusion and reperfusion in rabbits. J Thorac Cardiovasc Surg. 1994;107:1222-1227.

Perry MO. The hemodynamics of temporary abdominal aortic occlusion. Ann Surg. 1968;168:193-200.

Gottlieb A. Aortic reconstructive surgery: anesthetic considerations. Curr Opin Anesth. 1993;6:35-46.

Reiz S, Peter T, Rais O. Hemodynamic and cardiometabolic effects of infrarenal aortic and common iliac artery desclamping in man - an approach to optimal volume loading. Acta Anaesthesiol Scand. 1979;23:579-586.

Colson P, Capdevilla X, Cuchet D. Does choice of the anesthetic influence renal function during infrarenal aortic surgery?. Anesth Analg. 1992;74:481-485.

Bisinotto FMB, Braz JRC. Efeitos do halotano, isoflurano e sevoflurano nas respostas cardiovasculares ao pinçamento aórtico infra-renal. Estudo experimental em cães. Rev Bras Anestesiol. 2003;53:467-480.

Efeitos hemodinâmicos da oclusão da aorta durante anestesia inalatória com isoflurano e sevoflurano: estudo experimental em cães

Hemodynamic effects of aortic occlusion during inhalational anesthesia with isoflurane and sevoflurane: experimental study in dogs

Artur Udelsmann; Derli Conceição Munhoz; Álvaro Edmundo Simões Ulhoa Cintra; José Eduardo Tanus dos Santos

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