Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942009000200012
Brazilian Journal of Anesthesiology
Review Article

Anestesia neuroaxial comparada à anestesia geral para revascularização dos membros inferiores em idosos: revisão sistemática com metanálise de ensaios clínicos aleatórios

Neuroaxis block compared to general anesthesia for revascularization of the lower limbs in the elderly: a systematic review with metanalysis of randomized clinical studies

Fabiano Timbó Barbosa; Mário Jorge Jucá; Aldemar Araújo Castro

http://dx.doi.org/10.1590/S0034-70942009000200012 Braz J Anesthesiol, vol.59, n2, p.234-243, 2009
PDF Português
PDF English
Downloads: 1
Views: 1060

Resumo

JUSTIFICATIVA E OBJETIVOS: A controvérsia atual é saber se a anestesia neuroaxial (AN) é mais eficiente que a geral (AG) em idosos submetidos à cirurgia não-cardíaca. O objetivo foi determinar a eficiência da AN comparada à AG para revascularização de membros inferiores (RMI) em idosos. MÉTODO: Utilizada estratégia de busca para as bases de dados: MEDLINE (1955 a 2007), CINHAL ( 1982 a 2007), Embase (1980 a 2007), LILACS (1982 a 2007) e ISI (1945 a 2007). Dois revisores analisaram independentemente os artigos em busca de ensaios clínicos aleatórios (ECA) que comparassem a AN com a AG para a RMI. O texto completo dos ECA que atendessem aos critérios de inclusão foram analisados. Discordâncias foram analisadas em reuniões de consenso. A metanálise foi realizada com o software Review Manager, por meio da razão de chances com intervalo de confiança de 95%. RESULTADOS: Foram selecionados três artigos originais envolvendo 465 pacientes. Não houve significância estatística na metanálise das variáveis: mortalidade (OR: 0,90; IC 95%: 0,30 - 2,73; P = 0,85 raquianestesia; OR: 1,30; IC 95%: 0,38 - 4,48; P = 0,68 anestesia peridural), infarto miocárdico (OR: 1,38; IC 95%: 0,29 - 6,46; P = 0,68) e taxa de amputação dos membros inferiores (OR: 0,81; IC 95%: 0,30 - 2,19; P = 0,68 raquianestesia; OR: 0,70; IC 95%: 0,24 - 2,07; P = 0,52 anestesia peridural). Houve significância estatística para pneumonia (OR: 0,37; IC 95%: 0,15 - 0,89; P = 0,03), porém houve heterogeneidade clínica. CONCLUSÕES: As evidências geradas nessa metanálise foram insuficientes para demonstrar que a AN é mais eficiente, equivalente, ou menos eficiente quando comparada a AG para RMI em idosos.

Palavras-chave

CIRURGIA, TÉCNICAS ANESTÉSICAS, TÉCNICAS ANESTÉSICAS

Abstract

BACKGROUND AND OBJECTIVES: Currently, it is controversial on whether neuroaxis block (NB) is more effective than general anesthesia (GA) in elderly individuals undergoing non-cardiac surgeries. The objective of this study was to determine the efficiency of NB in comparison to GA for revascularization of the lower limbs (RLL) in the elderly. METHODS: A search of the following data base was conducted: MEDLINE (1955 to 2007), CINHAL (1982 to 2007), EMBASE (1980 to 2007), LILACS (1982 to 2007), and ISI (1945 to 2007). Two investigators undertook an independent analysis of the studies published to identify randomized clinical trials (RCTs) comparing NB with GA for RLL. The full text of the RCTs that fulfill the inclusion criteria was analyzed. Disagreements were analyzed in consensus meetings. The software Review Manager was used for the Metanalysis by means of odds ratio with a confidence interval of 95%. RESULTS: Three studies involving 465 patients were selected. Metanalysis of the following parameters did not show statistically significant differences: mortality (OR: 0.90; CI 95%: 0.30-2.73; p = 0.85 for spinal anesthesia; OR: 1.30, CI 95%: 0.38-4.48, p = 0.68, for epidural block); myocardial infarction (OR: 1.38, CI 95%: 0.29-6.46, p = 0.68); and rate of lower limb amputation (OR: 0.81, CI 95%: 0.30-2.19, p = 0.68, for spinal block; OR: 0.70, CI 95%: 0.24-2.07, p = 0.52 for epidural block). A statistically significant difference was observed for pneumonia (OR: 0.37, CI 95%: 0.15-0.89, p = 0.03); however, clinical heterogeneity was present. CONCLUSIONS: This metanalysis did not generate enough evidence to demonstrate that NB is more efficient, equivalent, or less efficient than GA for RLL in the elderly.

Keywords

ANESTHETIC TECHNIQUES, ANESTHETIC TECHNIQUES, SURGERY

Referências

Sielenkãmper AW, Booke M. Anaesthesia and the elderly. Curr Opin Anaesthesiol. 2001;14:679-684.

Roy RC. Choosing general versus regional anesthesia for the elderly. Anesthesiol Clin North America. 2000;18:91-104.

Borgeat A, Ekatdramis G. Orthopaedic surgery in the elderly. Best Pract Res Clin Anaesthesiol. 2003;17:235-244.

Barbosa FT, Cavalcante JC, Jucá MJ. Neuraxial anaesthesia for lower-limb revascularization (Protocol for a Cochrane Review). Cochrane Database Syst Rev. 2008.

Altman DG. Randomisation. BMJ. 1991;302:1481-1482.

Review Manager (RevMan) [Programa de Computador]: Versão 4.2 para Windows. 2003.

Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;15:1539-1558.

Cook PT, Davies MJ, Cronin KD. A prospective randomized trial comparing spinal anaesthesia using hyperbaric cinchocaine with general anaesthesia for lower limb vascular surgery. Anaesth Intensive Care. 1986;14:373-380.

Christopherson R, Beattie C, Frank SM. Perioperative morbidity in patients randomized to epidural or general anesthesia for lower extremity vascular surgery. Anesthesiology. 1993;79:422-434.

Pierce ET, Pomposelli Jr FB, Stanley GD. Anesthesia type does not influence early graft patency or limb salvage rates of lower extremity arterial bypass. J Vasc Surg. 1997;25:226-232.

Tuman KJ, Ivankovich AD. Pro: Regional anesthesia is better than general anesthesia for lower extremity revascularization. J Cardiothorac Vasc Anesth. 1994;8:114-117.

Yazigi A, Madi-Gebara S, Haddad F. Combined sciatic and femoral nerve blocks for infrainguinal arterial bypass surgery: a case series. J Cardiothorac Vasc Anesth. 2005;19:220-221.

Gilbert TB, Hawkes WG, Hebel JR. Spinal anesthesia versus general anesthesia for hip fracture repair: a longitudinal observation or 741 elderly patients during 2-yeat follow-up. Am J Orthop. 2000;29:25-35.

O'Hara DA, Duff A, Berlin JA. The effect of anesthetic technique on postoperative outcomes in hip fracture repair. Anesthesiology. 2000;92:947-957.

Dukelgrun M, Schouten O, Feringa HH. Beneficial effects of statins on perioperative cardiovascular outcome. Curr Opin Anaesthesiol. 2006;19:418-422.

Bronhein D. Statins and the perioperative period. Semin Cardiothorac Vasc Anesth. 2007;11:231-236.

Landesberg G. The pathophysiology of perioperative myocardial infarction: facts and perspectives. J Cardiothorac Vasc Anesth. 2003;17:90-100.

Venkataraman R. Vascular surgery critical care: perioperative cardiac optimization to improve survival. Crit Care Med. 2006;34(^s9):s200-s207.

5dd688120e88255550c8fca6 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