Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942008000300001
Brazilian Journal of Anesthesiology
Scientific Article

Remifentanil versus Sufentanil em infusão contínua em intervenções cirúrgicas videolaparoscópicas: estudo comparativo

Continuous infusion of remifentanil versus sufentanil in videolaparoscopic surgeries: a comparative study

Ricardo Francisco Simoni; Antônio Márcio Sanfim Arantes Pereira; Renato dos Santos Borega; Daniel Caldeira Pereira Simões

http://dx.doi.org/10.1590/S0034-70942008000300001 Braz J Anesthesiol, vol.58, n3, p.193-201, 2008
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Resumo

JUSTIFICATIVA E OBJETIVOS: A infusão contínua (IC) de remifentanil na técnica de anestesia venosa total é prática comum. Já o sufentanil em IC para cirurgias de curta/média duração tem sido pouco utilizado. O objetivo desse estudo foi comparar duas técnicas de anestesia venosa total, utilizando remifentanil ou sufentanil em IC, quanto ao comportamento anestésico no intra-operatório e às características da recuperação anestésica em pacientes submetidos à videolaparoscopia. MÉTODO: Participaram desse estudo 60 pacientes divididos em 2 grupos iguais (GR e GS). O GR foi induzido com remifentanil IC e o GS com sufentanil em bolus associado à IC. A IC de remifentanil era desligada ao fim da cirurgia, enquanto a IC de sufentanil, 20 minutos antes. Os pacientes receberam no intra-operatório cetoprofeno e dipirona. Como analgésico de resgate na sala de recuperação pós-anestésica (SRPA) foi utilizado tramadol. Foram analisados as variações da pressão arterial média (PAM) e freqüência cardíaca (FC), o tempo de despertar, o consumo de propofol, as intercorrências na SRPA e o tempo de permanência na SRPA. RESULTADOS: A média da PAM foi maior no GS em relação ao GR (91,9 × 77,6, p < 0,0001). A incidência de dor foi significativamente maior no GR em relação ao GS (22 × 1 paciente, p < 0,0001). A incidência de NVPO foi maior no GR em relação ao GS (10 × 2 pacientes, p = 0,0098). A média do tempo de permanência na SRPA foi maior no GR em relação ao GS (76 × 49 min, p < 0,0001). CONCLUSÕES: O controle hemodinâmico foi satisfatório nos grupos. A IC de sufentanil promoveu melhor controle da dor no pós-operatório com menor consumo de analgésico de resgate; conseqüentemente, houve menor incidência de NVPO e menor tempo de permanência na SRPA.

Palavras-chave

ANESTÉSICOS, Venoso, ANESTÉSICOS, Venoso, CIRURGIA, abdominal, videolaparoscópica

Abstract

BACKGROUND AND OBJECTIVES: Continuous infusion (CI) of remifentanil is common in total intravenous anesthesia. On the other hand, CI of sufentanil for short/medium-term surgeries has not been widely used. The objective of this study was to compare two techniques of total intravenous anesthesia, using CI of remifentanil or sufentanil, regarding their intraoperative behavior and characteristics of recovery of patients undergoing videolaparoscopic surgeries. METHODS: Sixty patients, equally divided in 2 groups (RG and SG), participated in this study. Continuous infusion of remifentanil was used for anesthetic induction in RG, while a bolus of sufentanil associated with CI of this drug was used in SG. The CI of remifentanil was discontinued at the end of the surgery, while the CI of sufentanil was discontinued 20 minutes before the end of the surgery. Patients received ketoprofen and dypirone intraoperatively. Tramadol was used for rescue analgesia in the recovery room. Variations of mean arterial pressure (MAP) and hard reate (HR), time for awakening, propofol consumption, intercurrences in the recovery room, and time of stay in the recovery room were analyzed. RESULTS: Mean MAP was greater in SG than in RG (91.9 × 77.6, p < 0.0001). The incidence of pain was significantly greater in RG than on SG (22 × 1 patient, p < 0.0001). The incidence of postoperative nausea and vomiting (PONV) was greater in RG than in SG (10 × 2 patients, p < 0.0098). The mean time of stay in the recovery room was greater in RG than in SG (76 × 49 min, p < 0.0001). CONCLUSIONS: Hemodynamic control was satisfactory in both groups. Continuous infusion of sufentanil promoted better postoperative pain control with decreased consumption of rescue analgesic and, consequently, reduced incidence of PONV and reduced time of stay in the recovery room.

Keywords

ANESTHETICS, Intravenous, ANESTHETICS, Intravenous, SURGERY, abdominal, videolaparoscopic

Referências

Glass PSA, Shafer SL, Reves JG. Intravenous Drug Delivery System. Anesthesia. 2000:377-411.

Derrode N, Lebrun F, Levron J. Influence of peroperative opioid on postoperative pain after major abdominal surgery: sufentanil TCI versus remifentanil TCI. Br J Anaesth. 2003;91:842-9.

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

Minto C, Schnider T, Shafer SL. Pharmacokinetics and pharmacodynamics of remifentanil. Anesthesiology. 1997;86:24-33.

Hughes MA, Glass PSA, Jacobs JR. Context-sensitive half-time in multicompartment pharmacokinetics models for intravenous drugs. Anesthesiology. 1992;76:334-341.

Lysakowsky C, Dumont L, Pellégrini M. Effects of fentanyl, alfentanil, remifentanil and sufentanil on loss of consciousness and bispectral index during propofol induction of anaesthesia. Br J Anaesth. 2001;86:523-527.

Hoymork SC, Raeder J, Grimsmo B. Bispectral index, serum drug concentration and emergence associated with individually adjusted target-controlled infusions of remifentanil and propofol for laparoscopic surgery. Br J Anaesth. 2003;91:773-780.

Vuyk J, Mertens MJ, Olofsen E. Propofol anesthesia and rational opioid selection. Anesthesiology. 1997;87:1549-1562.

Mertens MJ, Olofsen E, Engbers FHM. Propofol reduces perioperative remifentanil requirements in a synergistic manner. Anesthesiology. 2003;99:347-359.

Lentschener C, Ghimouz A, Bonnichon P. Remifentanil-propofol vs sufentanil-propofol: optimal combinations in clinical anesthesia. Acta Anaesthesiol Scand. 2003;47:84-89.

Smith OHGW, Nielsen LA. Postoperative hyperalgesia: its clinical importance and relevance. Anesthesiology. 2006;104:601-607.

Jensen K, Kehlet H, Lund C. Postoperative recovery profile after laparoscopic cholecystectomy. Acta Anaesthesiol Scand. 2007;51:464-471.

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