Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942007000500001
Brazilian Journal of Anesthesiology
Scientific Article

Complicações respiratórias em pacientes com paralisia cerebral submetidos à anestesia geral

Respiratory complications in patients with cerebral palsy undergoing general anesthesia

Sérgio Silva de Mello; Ronaldo Soares Marques; Renato Ângelo Saraiva

http://dx.doi.org/10.1590/S0034-70942007000500001 Braz J Anesthesiol, vol.57, n5, p.455-464, 2007
PDF Português
PDF English
Downloads: 1
Views: 1096

Resumo

JUSTIFICATIVA E OBJETIVOS: Anestesia em pacientes com paralisia cerebral (PC) pode representar um desafio para o anestesiologista. Este estudo prospectivo teve como objetivo determinar a prevalência e o risco de complicações respiratórias em crianças com PC submetidas à anestesia geral inalatória (AGI) para tomografia computadorizada (TC). MÉTODO: Participaram do estudo pacientes com idades entre 1 e 17 anos, estado físico ASA I a III, submetidos a AGI com sevoflurano e máscara laríngea para TC no período de junho/2002 a junho/2003, divididos em três grupos: PC tetraplégicos (PCT), outros tipos de PC (PCO) e paciente sem PC (NPC). Os pais ou responsáveis responderam a um questionário com perguntas sobre o histórico médico dos pacientes, infecção de vias aéreas superiores (IVAS), asma, convulsão, incoordenação orofaríngea, refluxo gastroesofágico, etc. Dados sobre incidência e gravidade das complicações respiratórias foram coletados prospectivamente (tosse, broncoespasmo, laringoespasmo, hipoxemia, aspiração). A amostra foi calculada para uma incidência esperada de 5% no grupo NPC, com uma diferença de 15% entre os grupos (alfa = 0,05 e beta = 0,1), utilizando-se os testes do Qui-quadrado, exato de Fisher e t de Student. RESULTADOS: Compuseram a amostra 290 pacientes divididos nos grupos da seguinte forma: PCT - 100, PCO - 79 e NPC - 111. Não houve diferença na prevalência de complicações respiratórias entre os grupos PCT (4%), PCO (8,9%) e NPC (7,3%). Houve associação entre a presença de IVAS e a ocorrência de complicações (risco relativo, 10,71). CONCLUSÕES: Crianças com paralisia cerebral tipo tetraplegia espástica não parecem ter um risco aumentado de complicações respiratórias durante anestesia geral inalatória com sevoflurano e máscara laríngea. O estudo confirma IVAS como fator de risco para a ocorrência dessas complicações.

Palavras-chave

ANESTESIA, Geral, DOENÇAS, neurológica, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJETIVES: Anesthesia in patients with cerebral palsy (CP) poses a challenge for the anesthesiologist. The objective of this prospective study was to determine the prevalence and risk of respiratory complications in children with CP undergoing general inhalational anesthesia for computed tomography. METHODS: Patients with ages ranging from 1 to 17 years, physical status ASA I to III, undergoing general inhalational anesthesia with sevoflurane and laryngeal mask for a CT scan from June 2002 to June 2003, participated in this study. Patients were divided in 3 groups: quadriplegic CP (CPQ), other types of CP (CPO), and patients without CP (NCP). Parents or guardians answered a questionnaire that assessed the past medical history of the patient, upper respiratory infections (URI), asthma, seizures, oropharyngeal dysfunction, gastroesophageal reflux, etc. Data on the incidence and severity of respiratory complications were gathered prospectively (cough, bronchospasm, laryngeal spasm, hypoxemia, aspiration, etc). The size of the study group was calculated for an expected 5% incidence in the NCP group, with a 15% difference among groups (alpha = 0.05 and beta = 0.1), using the Chi-square test, Fisher exact test, and test t Student. RESULTS: Two hundred and ninety patients, divided in three groups, participated in this study. Groups were composed of: CPQ = 100 patients, CPO = 79 patients, and NCP = 111 patients. There were no differences on the prevalence of respiratory infections among the CPQ (4%), CPO (8.9%), and NCP (7.3%) groups. There was a correlation between the presence of URI and the development of complications (relative risk of 10.71). CONCLUSIONS: Children with cerebral palsy with spastic quadriplegia do not seem to have an increased risk of respiratory complications during general inhalational anesthesia with sevoflurane and laryngeal mask. This study confirms URI as a risk factor for the development of those complications.

Keywords

ANESTHESIA, General, COMPLICATION, DISEASES, Neurologic

References

Bax M, Goldestein M, Rosenbaum P. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol. 2005;47:571-576.

Aicardi J, Bax M. Cerebral Palsy. Diseases of the Nervous System in Childhood. 1999:210-240.

Wongprasartsuk P, Rosenbaum P. Cerebral palsy and anaesthesia. Paediatr Anaesth. 2002;12:296-303.

Maranhão MVM. Anestesia e paralisia cerebral. Rev Bras Anestesiol. 2005;55:680-702.

Salem MR, Klowden AJ. Anesthesia for Orthopedic Surgery. Pediatric Anesthesia. 2002:617-662.

Zuckerberg AL, Yaster M. Anesthesia for Orthopedic Surgery. Smith's Anesthesia for Infants and Children. 1996:605-632.

McLeod ME, Creighton RE. Central Nervous System Diseases. Anesthesia and Uncommon Pediatric Disease. 1993:74-99.

Hepaguslar H, Ozzeybek D, Elar Z. The effect of cerebral palsy on the action of vecuronium with or without anticonvulsants. Anaesthesia. 1999;54:593-596.

Theroux MC, Brandon BW, Zagnoev M. Dose response of succinylcholine at the adductor pollicis of children with cerebral palsy during propofol and nitrous oxide anesthesia. Anesth Analg. 1994;79:761-765.

Frei FJ, Haemmerle MH, Brunner R. Minimum alveolar concentration for halothane in children with cerebral palsy and severe mental retardation. Anaesthesia. 1997;52:1056-1060.

Choudhry DK, Brenn BR. Bispectral index monitoring: a comparison between normal children and children with quadriplegic cerebral palsy. Anesth Analg. 2002;95:1582-1585.

Mello SM, Saraiva RA. Alterações eletroneurofisiológicas em anestesia com sevoflurano: estudo comparativo entre pacientes saudáveis e pacientes com paralisia cerebral. Rev Bras Anestesiol. 2003;53:150-159.

Stasikelis PJ, Lee DD, Sullivan CM. Complications of osteotomies in severe cerebral palsy. J Pediatr Orthop. 1999;19:207-210.

Campos da Paz Jr A, Burnett SM, Nomura AM. Neuromuscular Affections in Children. Mercer's Orthopaedic Surgery. 1996:444-473.

Theroux MC, Akins RE. Surgery and anesthesia for children who have cerebral palsy. Anesthesiol Clin North Am. 2005;23:733-743.

Tait AR, Shobha M, Voepel-lewis T. Risk factors for perioperative adverse respiratory events in children with upper respiratory tract infections. Anesthesiology. 2001;95:299-306.

Eger II EI. The pharmacology of inhaled anesthetics. Semin Anesth Perioper Med Pain. 2005;24:89-100.

Tait AR, Pandit UA, Voepel-lewis T. Use of the laryngeal mask airway in children with upper respiratory tract infections: a comparison with endotracheal intubation. Anesth Analg. 1998;86:706-711.

Skolnick ET, Vomvolakis MA, Buck KA. Exposure to environmental tobacco smoke and the risk of adverse respiratory events in children receiving general anesthesia. Anesthesiology. 1998;88:1144-1153.

Parnis SJ, Barker DS, Van der Walt JH. Clinical predictors of anaesthetic complications in children with respiratory tract infections. Paediatr Anaesth. 2001;11:29-40.

Tait AR, Malviya S. Anesthesia for the child with an upper respiratory tract infection: still a dilemma?. Anesth Analg. 2005;100:59-65.

5dd81fc00e88257b7a13f286 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections