Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942007000200012
Brazilian Journal of Anesthesiology
Review Article

Uso de dexmedetomidina em neurocirurgia

The use of dexmedetomidine in neurosurgery

Bernardo Aloisio Grings Herbert; Paulo Magalhães Gomes Ramaciotti; Fábio Ferrari; Laís Helena Camacho Navarro; Giane Nakamura; Geraldo Rolim Rodrigues Jr; Yara Marcondes Machado Castiglia; José Reinaldo Cerqueira Braz; Paulo do Nascimento Jr

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Resumo

JUSTIFICATIVA E OBJETIVOS: Os fármacos alfa2-agonistas são a cada dia mais utilizados em Anestesiologia, seja como adjuvantes ou como agentes anestésicos únicos. Atualmente, o emprego da dexmedetomidina vem se popularizando devido à sua maior seletividade aos receptores alfa2 e, também, ao seu perfil farmacocinético. O objetivo desta revisão foi fazer uma análise do emprego da dexmedetomidina em neurocirurgia. CONTEÚDO: Além das considerações e revisão da literatura quanto ao emprego da dexmedetomidina especificamente em procedimentos neurocirúrgicos, foi realizada descrição dos efeitos do fármaco nos diversos sistemas do organismo. CONCLUSÕES: A dexmedetomidina tem perfil farmacocinético e farmacodinâmico que favorece seu emprego em diversos procedimentos neurocirúrgicos. A utilização clínica em procedimentos cirúrgicos com craniotomia para pinçamento de aneurisma e remoção de tumores é crescente. Além disso, seu uso em intervenções cirúrgicas funcionais é promissor.

Palavras-chave

CIRURGIA, Neurocirurgia, DROGAS, Agonista adrenérgico

Abstract

BACKGROUND AND OBJECTIVES: The use of alpha2-adrenergic agonists is increasingly more frequent in Anesthesiology, as adjuvant or the sole anesthetic drug. Currently, dexmedetomidine is gaining popularity due to its greater selectivity for the alpha2-adrenergic receptors and its pharmacokinetic profile. The aim of this review was to analyze the use of dexmedetomidine in neurosurgery. CONTENTS: Besides considerations and review of the literature regarding the use of dexmedetomidine, specifically in neurosurgical procedures, its effects on the different organ systems are described. CONCLUSIONS: The pharmacokinetic and pharmacodynamic profile of dexmedetomidine favors its use in several neurosurgical procedures. Its use in craniotomy for the treatment of aneurysms and tumor removal is recent. Besides, its use in functional surgical interventions is promising.

Keywords

DRUGS, Adrenergic Agonists, SURGERY, Neurosurgery

References

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

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.

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

Curtis FG, Castiglia YMM, Stolf AA. Dexmedetomidina e sufentanil como analgésicos per-operatórios: Estudo comparativo. Rev Bras Anestesiol. 2002;52:525-534.

Marangoni MA, Castiglia YMM, Medeiros TP. Eficácia analgésica da dexmedetomidina comparada ao sufentanil em cirurgias intraperitoneais: Estudo comparativo. Rev Bras Anestesiol. 2005:19-27.

Bloor BC, Ward DS, Belleville JP. Effects of intravenous dexmedetomidine in humans. II: Hemodynamic changes. Anesthesiology. 1992;77:1134-1142.

Dyck JB, Maze M, Haack C. The pharmacokinetics and hemodynamic effects of intravenous and intramuscular dexmedetomidine hydrocholoride in adult human volunteers. Anesthesiology. 1993;78:813-820.

Karol MD, Maze M. Pharmacokinetics and interaction of dexmedetomidine in humans. Ballière Clin Anesthesiol. 2000;14:261-269.

Kamibayashi T, Maze M. Clinical uses of alpha2-adrenergic agonists. Anesthesiology. 2000;93:1345-1349.

Civantos Calzada B, Aleixandre de Artinano A. Alpha-adrenoceptor subtypes. Pharmacol Res. 2001;44:195-208.

Scheinin M. Pihlavisis M Molecular pharmacology of alpha2-adrenoceptor agonists. 2000:247-260.

Hodgson PS, Liu SS. New developments in spinal anesthesia. Anesthesiol Clin North Am. 2000;18:235-249.

McCallum JB, Boban N, Hogan Q. The mechanism of alpha2-adrenergic inhibition of sympathetic ganglionic transmission. Anesth Analg. 1998;87:503-510.

Khan ZP, Ferguson CN, Jones RM. Alpha2 and imidazoline receptor agonists: Their pharmacology and therapeutic role. Anaesthesia. 1999;54:146-165.

Talke P, Chen R, Thomas B. The hemodynamic and adrenergic effects of perioperative dexmedetomidine infusion after vascular surgery. Anesth Analg. 2000;90:834-839.

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

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

Talke P, Lobo E, Brown R. Systemically administered alpha2-agonist-induced peripheral vasoconstriction in humans. Anesthesiology. 2003;99:65-70.

Villela NR, Nascimento Jr P, Carvalho LR. Efeitos cardiovasculares de duas doses de dexmedetomidina. Estudo experimental em cães. Rev Bras Anestesiol. 2003;53:784-796.

Bekker A, Gold M, Basile J. Hemodynamic and respiratory changes related to the use of dexmedetomidine in patients undergoing awake carotid endarterectomy. Anesthesiology. 2003;100:A136.

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

Wijeysundera DN, Naik JS, Beattie WS. Alpha2 adrenergic agonists to prevent perioperative cardiovascular complications: a meta-analysis. Am J Med. 2003;114:742-752.

Groeben H, Mitzner W, Brown RH. Effects of the alpha2-adrenoceptor agonist dexmedetomidine on bronchoconstriction in dogs. Anesthesiology. 2004;100:359-363.

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

Venn RM, Bryant A, Hall GM. Effects of dexmedetomidine on adrenocortical function, and the cardiovascular, endocrine, and inflammatory responses in postoperative patients needing sedation in the intensive care unit. Br J Anaesth. 2001;86:650-656.

Xu H, Aibiki M, Seki K. Effects of dexmedetomidine, an alpha2-adrenoceptor agonist, on renal sympathetic nerve activity, blood pressure, heart rate and central venous pressure in urethane-anesthetized rabbits. J Auton Nerv Syst. 1998;71:48-54.

Villela NR, Nascimento Jr P, Carvalho LR. Efeitos da dexmedetomidina sobre o sistema renal e sobre a concentração plasmática do hormônio antidiurético: Estudo experimental em cães. Rev Bras Anestesiol. 2005;55:429-440.

Pettinger WA, Umemura S, Smyth DD. Renal alpha2-adrenoceptors and the adenylate cyclase-cAMP system: biochemical and physiological interactions. Am J Physiol. 1987;252:F199-208.

Malmberg AB, Hedley LR, Jasper JR. Contribution of alpha2 receptor subtypes to nerve injury-induced pain and its regulation by dexmedetomidine. Br J Pharmacol. 2001;132:1827-1836.

Stone LS, MacMillan LB, Kitto KF. The alpha2A adrenergic receptor subtype mediates spinal analgesia evoked by alpha2 agonists and is necessary for spinal adrenergic-opioid synergy. J Neurosci. 1997;17:7157-7165.

Unlugenc H, Gunduz M, Guler T. The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine. Eur J Anaesthesiol. 2005;22:386-391.

Martin E, Ramsay G, Mantz J. The role of alpha2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intens Care Med. 2003;18:29-41.

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

Karlsson BR, Forsman M, Roald OK. Effect of dexmedetomidine, a selective and potent alpha2-agonist, on cerebral blood flow and oxygen consumption during halothane anesthesia in dogs. Anesth Analg. 1990;71:125-129.

Zornow MH, Fleischer JE, Scheller MS. Dexmedetomidine, an alpha2-adrenergic agonist, decreases cerebral blood flow in the isoflurane-aneshetized dog. Anesth Analg. 1990;70:624-630.

McPherson RW, Koehler RC, Traystman RJ. Hypoxia, alpha2-adrenergic, and nitric oxide-dependent interactions on canine cerebral blood flow. Am J Physiol. 1994;266:H482.

Lam AM, Bhatia S, Lee LA. Influence of dexmedetomidine on CO2 reactivity and cerebral autoregulation in healthy volunteers. Anesthesiology. 2001;95:A341.

Ohata H, Iida H, Dohi S. Intravenous dexmedetomidine inhibits cerebrovascular dilatation induced by isoflurane and sevoflurane in dogs. Anesth Analg. 1999;89:370-377.

Ulrich K, Kuschinsky W. In vivo effects of alpha-adrenoreceptor agonists and antagonists on pial veins of cats. Stroke. 1985;16:880-884.

Zornow MH, Scheller MS, Sheehan PB. Intracranial pressure effects of dexmedetomidine in rabbits. Anesth Analg. 1992;75:232-237.

Talke P, Tong C, Lee HW. Effect of dexmedetomidine on lumbar cerebrospinal fluid pressure in humans. Anesth Analg. 1997;85:358-364.

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

Jolkkonen J, Puurunen K, Koistinaho J. Neuroprotection by the alpha2-adrenoceptor agonist, dexmedetomidine, in rat focal cerebral ischemia. Eur J Pharmacol. 1999;372:31-36.

Paris A, Tonner PH. Dexmedetomidine in anaesthesia. Curr Opin Anaesthesiol. 2005;18:412-418.

Kuhmonen J, Pokorny J, Miettinen R. Neuroprotective effects of dexmedetomidine in the gerbil hippocampus after transient global ischemia. Anesthesiology. 1997;87:371-377.

Engelhard K, Werner C, Eberspacher E. The effect of the alpha2-agonist dexmedetomidine and the N-methyl-D-aspartate antagonist S (+)-ketamine on the expression of apoptosis-regulating proteins after incomplete cerebral ischemia and reperfusion in rats. Anesth Analg. 2003;96:524-531.

Chen Y, Zhao Z, Code WE. A correlation between dexmedetomidine-induced biphasic increases in free cytosolic calcium concentration and energy metabolism in astrocytes. Anesth Analg. 2000;91:353-357.

Talke P, Bickler PE. Effects of dexmedetomidine on hypoxia-evoked glutamate release and glutamate receptor activity in hippocampal slices. Anesthesiology. ;85:1996.

Laudenbach V, Mantz J, Langercrantz H. Effects of alpha2-adrenoceptor agonists on perinatal excitotoxic brain injury: comparison of clonidine and dexmedetomidine. Anesthesiology. 2002;96:134-141.

Bekker A, Sturaitis MK. Dexmedetomidine for neurological surgery. Neurosurgery. 2005;57:1-10.

Mack PF, Perrine K, Kobylarz E. Dexmedetomidine and neurocognitive testing in awake craniotomy. J Neurosurg Anesthesiol. 2004;16:20-25.

See JJ, Manninen PH. Anesthesia for neuroradiology. Curr Opin Anaesthesiol. 2005;18:437-441.

Everett LL, Van Rooyen IF, Warner MH. Use of dexmedetomidine in awake craniotomy in adolescents: report of two cases. Paediatr Anaesth. 2006;16:338-342.

Venkatraghavan L, Manninen P, Mak P. Anesthesia for functional neurosurgery. Review of complications. J Neurosurg Anesthesiol. 2006;18:64-67.

Bekker AY, Basile J, Gold M. Dexmedetomidine for awake carotid endarterectomy: efficacy, hemodynamic profile, and side effects. J Neurosurg Anesthesiol. 2004;16:126-135.

Lee CZ, Young WL. Anesthetic considerations for interventional neuroradiology. ASA Refresher Courses in Anesthesiol. 2005;33:145-154.

Pasternak JJ, Lanier WL. Neuroanesthesiology review. J Neurosurg Anesthesiol. 2005;17:2-8.

Sturatis M, Kroin J, Swamidoss CS. Effect of intraoperative dexmedetomidine infusion on hemodynamic stability during brain tumor resection. Anesthesiology. 2002;97:A310.

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