Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942008000400002
Brazilian Journal of Anesthesiology
Scientific Article

Avaliação das variações hemodinâmicas durante a indução anestésica em pacientes hipertensos tratados

Evaluation of hemodynamic variations during anesthetic induction in treated hypertensive patients

Walter Viterbo da Silva Neto; Giselli Santos Azevedo; Fernanda Oliveira Coelho; Eduardo Martins Netto; Ana Marice Ladeia

http://dx.doi.org/10.1590/S0034-70942008000400002 Braz J Anesthesiol, vol.58, n4, p.330-341, 2008
PDF Português
PDF English
Downloads: 0
Views: 895

Resumo

JUSTIFICATIVA E OBJETIVOS: Devido à alta prevalência da hipertensão arterial sistêmica, ao aumento da expectativa de vida e ao aprimoramento dos métodos diagnósticos e das técnicas cirúrgicas, essa comorbidade tornar-se-á comum em pacientes cirúrgicos. O objetivo deste estudo foi avaliar o comportamento das variáveis hemodinâmicas dos pacientes hipertensos tratados durante a indução anestésica. MÉTODO: Estudo observacional sobre o comportamento das variáveis hemodinâmicas (pressão arterial sistólica, pressão arterial diastólica e freqüência cardíaca) durante a indução anestésica dos pacientes hipertensos e normotensos, escalados para operações eletivas submetidos à anestesia geral em quatro momentos consecutivos durante a indução anestésica: preparo (MP), fármaco (MF), laringoscopia/intubação (ML) e laringoscopia/intubação 5 min (ML5). RESULTADOS: A amostra foi composta por 128 pacientes distribuídos nos grupos de pacientes hipertensos (GH) e normotensos (GN). Houve diminuição da PAD no momento MF em ambos os grupos, com menor redução percentual no GH (18,3 ± 14,0% versus 23,0 ± 11,4%, p = 0,04). Houve aumento das PAS e PAD no momento ML em ambos os grupos, com menores elevações percentuais no GH (8,2 ± 16,3% versus 18,2 ± 21,2%, p < 0,01; 8,6 ± 20,2% versus 25,0 ± 27,9%, p < 0,01; respectivamente para PAS e PAD). Quanto à PAS e PAD, após ML5, e à FC não houve diferença entre os grupos. CONCLUSÕES: Os pacientes hipertensos tratados com níveis pressóricos controlados apresentaram maior estabilidade hemodinâmica durante a indução anestésica.

Palavras-chave

ANESTESIA, DOENÇAS, SISTEMA CARDIOVASCULAR

Abstract

BACKGROUND AND OBJECTIVES: Due to the high prevalence of hypertension, the increase in life expectancy, and improvement of diagnostic methods and surgical techniques, this comorbidity will be increasingly more common in surgical patients. The objective of this study was to evaluate the behavior of the hemodynamic variables during anesthetic induction in treated hypertensive patients. METHODS: This is an observational study on the behavior of hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and heart rate) during the anesthetic induction of hypertensive and normotensive patients scheduled for elective surgeries under general anesthesia, at four moments: preparation (MP), drug (MD), laryngoscopy/intubation (ML), and 5 minutes after laryngoscopy/intubation (ML5). RESULTS: The sample was composed of 128 patients divided into two groups: hypertensive (GH) and normotensive (GN). Diastolic blood pressure was reduced at MD in both groups, with a smaller percentage reduction in GH (18.3 ± 14.0% versus 23.0 ± 11.4%, p = 0.04). There was an increase in SBP and DBP at ML in both groups, with smaller percentage reductions in GH (8.2 ± 16.3% versus 18.2 ± 21.2%, p < 0.01; 8.6 ± 20.2% versus 25.0 ± 27.9%, p < 0.01, respectively for DBP and SBP). As for ML5, HR, SBP and DBP did not show significant differences between both groups. CONCLUSIONS: Hypertensive patients under treatment and with controlled blood pressure levels demonstrated greater hemodynamic stability during anesthetic induction.

Keywords

ANESTHESIA, CARDIOVASCULAR SYSTEM, DISEASES

Referências

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. 2003.

IV Diretrizes Brasileiras de Hipertensão Arterial. Arq Bras Cardiol. 2004:8-14.

Fox EJ, Sklar GS, Hill CH. Complication related to the pressor response to endotracheal intubation. Anesthesiology. 1977;47:524-525.

Nocite JR. Fisiopatologia da hipertensão arterial e avaliação do paciente hipertenso. Rev Bras Anestesiol. ;38:257-262.

Balbino M. Anestesia e o paciente hipertenso. Rev Bras Anestesiol. 1998;48:320-330.

Forbes AM, Dally FG. Acute hypertension during induction of anaesthesia and endotracheal intubation in normotensive man. Br J Anaesth. 1970;42:618-624.

Carmona MJC, Piccioni MA, dos Santos LM. Avaliação pré-operatória do paciente cardiopata. Medicina Peri-operatória. 2005:193-238.

Imbelloni LE. Estudo comparativo entre fentanil e lidocaína venosa. Rev Bras Anestesiol. 1991;41:381-385.

Kovac AL. Controlling the hemodynamic response to laringoscopy and endotracheal intubation. J Clin Anesth. 1996;8:63-79.

Denlinger JK. Effects of intravenous lidocaine on the circulatory responses to tracheal intubation. Anesthesiology. 1976;31:463-480.

Lin PL, Wang YP, Chou YM. Lack of intravenous lidocaine effects on HRV changes of tracheal intubation during induction of general anesthesia. Acta Anaesthesiol Sin. 2001;39:77-82.

Claeys MA, Gepts E, Camus F. Haemodynamic changes during anaesthesia induced and maintained with propofol. Br J Anaesth. 1988;60:3-9.

White FP. Propofol: pharmacokinetics and pharmacodynamics. Semin Anesth. 1988;7:1-4.

Nocite JR, Serzedo PSMM, Zuculotto EB. Características Clínicas da Indução Anestésica e da Intubação Traqueal com Propofol. Rev Bras Anestesiol. 1990;40:385-390.

El-Beheiry H, Kim J, Milne B. Prophylaxis against the systemic hypotension induced by propofol during rapid-sequence intubation. Can J Anaesth. 1995;42:875-878.

Ebert TJ, Muzi M, Berens R. Sympathetic responses to induction of anesthesia in humans with propofol or etomidate. Anesthesiology. 1992;76:725-733.

Prys-Roberts C, Meloche R, Foex P. Studies of anesthesia in relation to hypertension. I: cardiovascular responses of treated and untreated patients. Br J Anaesth. 1971;43:122-137.

Goldman L, Caldera DL. Risks of general anesthesia and elective operation in the hypertensive patient. Anesthesiology. 1979;50:285-292.

Rocha JC, Rocha AT. Abordagem pré-operatória do paciente hipertenso: riscos e orientações. Rev Soc Cardiol Estado de São Paulo. 2000;10:311-316.

Stone JG, Foëx P, Sear JW. Risk of myocardial ischaemia during anaesthesia in treated and untreated hypertensive patients. Br J Anaesth. 1988;61:675-679.

Fleisher LA. Avaliação Pré-Operatória. Anestesia Clínica. 2004:473-489.

5dd6ab290e8825ef4213f289 rba Articles
Links & Downloads
2352-2291 (Eletrônico) 0104-0014 (Impresso)
Braz J Anesthesiol ©2024 Todos os direitos reservados.

Braz J Anesthesiol

Share this page
Page Sections