Anestesia regional intravenosa primeiro centenário (1908-2008): Início, desenvolvimento e estado atual

Almiro dos Reis Jr

doi:10.1590/S0034-70942008000300013

Special Article

Anestesia regional intravenosa primeiro centenário (1908-2008): Início, desenvolvimento e estado atual

Intravenous regional anesthesia first century (1908-2008): Beggining, development, and current status

Almiro dos Reis Jr

http://dx.doi.org/10.1590/S0034-70942008000300013 Braz J Anesthesiol, vol.58, n3, p.299-322, 2008

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Resumo

JUSTIFICATIVA E OBJETIVOS: A anestesia regional intravenosa completa neste ano de 2008 um século de existência. Sendo técnica anestésica amplamente utilizada, justifica-se recordar o fato, comemorar a data, lembrar aos anestesiologistas brasileiros o processo evolutivo pelo qual ela passou, sobretudo nos últimos 40 anos, e prestar um tributo àquele que a iniciou: August Karl Gustav Bier. CONTEÚDO: O texto relata a origem da anestesia locorregional em geral e da anestesia regional intravenosa em particular, desde a introdução do garroteamento de membros e da descoberta e do aperfeiçoamento das agulhas de punção, das seringas e dos anestésicos locais. São descritos os detalhes técnicos inicialmente utilizados por Bier e os conceitos fisiopatológicos e clínicos por ele emitidos em princípios do século XX. Retrata a evolução inicial e das décadas seguintes da anestesia regional intravenosa, cita os pioneiros nacionais e internacionais no seu uso, explica as razões do seu estudo científico relativamente tardio, descreve as principais contribuições havidas até hoje para sua utilização eficiente e segura. Finalmente, narra o estado atual dos principais conhecimentos adquiridos ao longo do tempo, como mecanismo e local de ação do anestésico e da isquemia, uso de soluções anestésicas modernas, aperfeiçoamento da analgesia pós-operatória e do bloqueio motor, conceitos farmacocinéticos e fisiopatológicos e melhor interpretação das principais complicações possíveis. CONCLUSÕES: A anestesia regional intravenosa é técnica anestésica criada por A.K.G. Bier há exatamente 100 anos. Evoluiu pouco e lentamente na primeira metade do século XX e muito nos últimos anos, graças a numerosos desenvolvimentos técnicos, fisiopatológicos, farmacológicos, farmacocinéticos e clínicos, para o que a Anestesiologia brasileira deu grande contribuição. Completando neste ano de 2008 seu primeiro centenário, a anestesia regional intravenosa merece ter sua história conhecida e a data não pode passar despercebida e sim ser lembrada e comemorada.

Palavras-chave

ANESTESIA, Regional, ANESTESIOLOGIA

Abstract

BACKGROUND AND OBJECTIVES: Intravenous regional block is celebrating its 100th anniversary in 2008. Since this is a widely used technique, this milestone should be recorded, the date celebrated, Brazilian anesthesiologists should be remembered of its evolutive process, especially in the last 40 years, and we should pay homage to the individual who started it: August Karl Gustav Bier. CONTENTS: This report describes the beginning of locoregional anesthesia in general and regional intravenous block in particular, since the introduction of garroting of the extremities to the discovery and improvement of needles, syringes, and local anesthetics. The technical details used initially by Bier, and the pathophysiological and clinical concepts enounced by him at the beginning of the 20th Century are described. It describes the initial evolution and that of the following decades of intravenous regional block, lists national and international pioneers, explains the reasons for the relatively late scientific studies on the technique, and describes the main contributions that made it an effective and safe technique. Finally, it describes the current state of the main knowledge acquired over the years, such as the mechanism and site of action of the anesthetic and ischemia, the use of modern anesthetic solutions, improvement of postoperative analgesia and motor block, pharmacokinetic and pathophysiological concepts, and the best interpretation of possible complications. CONCLUSIONS: Intravenous regional block is the anesthetic technique created by A. K. G. Bier exactly 100 years ago. In the first half of the 20th Century, it evolved little and slowly, but in the last several years, it has seen an accentuated improvement, thanks to countless technical, pathophysiological, pharmacological, pharmacokinetic, and clinical developments, for which Brazilian Anesthesiology has contributed considerably. Since it is celebrating its 100th anniversary in 2008, intravenous regional block deserves to have its story told, and the date should not go unnoticed, but should be remembered and celebrated.

Keywords

ANESTHESIA, Regional, ANESTHESIOLOGY

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Anestesia regional intravenosa primeiro centenário (1908-2008): Início, desenvolvimento e estado atual

Intravenous regional anesthesia first century (1908-2008): Beggining, development, and current status

Almiro dos Reis Jr

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