Efeitos hemodinâmicos da combinação de dexmedetomidina-fentanil versus midazolam-fentanil em crianças submetidas à cirurgia cardíaca com circulação extracorpórea

Jyrson Guilherme Klamt; Walter Villela de Andrade Vicente; Luis Vicente Garcia; César Augusto Ferreira

doi:10.1590/S0034-70942010000400002

Artigo Científico

Efeitos hemodinâmicos da combinação de dexmedetomidina-fentanil versus midazolam-fentanil em crianças submetidas à cirurgia cardíaca com circulação extracorpórea

Hemodynamic effects of the combination of dexmedetomidine-fentanyl versus midazolam-fentanyl in children undergoing cardiac surgery with cardiopulmonary bypass

Jyrson Guilherme Klamt; Walter Villela de Andrade Vicente; Luis Vicente Garcia; César Augusto Ferreira

http://dx.doi.org/10.1590/S0034-70942010000400002 Braz J Anesthesiol, vol.60, n4, p.356-362, 2010

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: Avaliar a eficácia da infusão combinada de dexmedetomidina e fentanil na resposta hemodinâmica durante cirurgia cardíaca com circulação extracorpórea (CEC) em crianças. MÉTODO: Trinta e duas crianças com idade entre 1 mês e 10 anos, agendadas para cirurgia cardíaca com circulação extracorpórea, foram distribuídas de modo aleatório em dois grupos: o Grupo MDZ recebeu midazolam 0,2 mg.kg-1.h-1, enquanto o Grupo DEX recebeu dexmedetomidina 1 µg.kg-1.h-1 durante uma hora e, em seguida, o ritmo de infusão foi reduzido à metade em ambos os grupos. Ambos os grupos receberam fentanil 10 µg.kg-1, midazolam 0,2 mg.h-1 e vecurônio 0,2 mg.kg-1 para indução da anestesia. As mesmas doses de fentanil com vecurônio da indução foram infundidas durante a primeira hora após a indução e, em seguida, reduzidas à metade. As infusões foram iniciadas imediatamente após a indução e mantidas até o final da cirurgia. O isoflurano foi administrado por curto tempo para controle da resposta hiperdinâmica à incisão e esternotomia. RESULTADOS: Em ambos os grupos, a pressão arterial sistólica e a frequência cardíaca reduziram de modo significativo após uma hora de infusão anestésica, porém o aumento da pressão arterial sistólica e diastólica e da frequência cardíaca à incisão da pele foram significantemente menores no Grupo DEX. Um número significativamente menor de pacientes demandaram suplementação com isoflurano no Grupo DEX. Após a CEC, os pacientes de ambos os grupos tiveram respostas hemodinâmicas similares. CONCLUSÕES: A infusão sem bolus de dexmedetomidina parece ser um adjuvante efetivo do fentanil na promoção de sedação e controle das respostas hemodinâmicas durante cirurgia para cardiopatias congênitas em crianças.

Palavras-chave

ANALGÉSICOS, Opioides, CIRURGIA, Cardíaca, DROGAS, Agonista adrenérgico, MEDICAÇÃO PRÉ-ANESTÉSICA

Abstract

BACKGROUND AND OBJECTIVES: To evaluate the efficacy of the combined infusion of dexmedetomidine and fentanyl on the hemodynamic response during cardiac surgery with cardiopulmonary bypass (CPB) in children. METHODS: Thirty-two children, ages 1 month to 10 years, scheduled for cardiac surgery with cardiopulmonary bypass were randomly divided in two groups: the MDZ Group received midazolam 0.2 mg.kg-1.h-1, while the DEX group received dexmedetomidine 1 µg.kg-1.h-1 during one hour followed be a reduction by half in the rate of infusion in both groups. Both groups received fentanyl 10 µg.kg-1, midazolam 0.2 mg.h-1, and vecuronium 0.2 mg.kg-1 for anesthesia induction. The same doses of fentanyl and vecuronium used during induction were infused during the first hour after induction, followed by a reduction to half. Infusions were initiated immediately after induction and maintained until the end of the surgery. Isoflurane was administered for a short time to control the hyperdynamic response to incision and sternotomy. RESULTS: In both groups, systolic blood pressure and heart rate reduced significantly after one hour of anesthetic infusion, but the increase in systolic and diastolic pressure and heart rate to skin incision were significantly lower in the DEX Group. A significantly lower number of patients demanded supplementation with isoflurane in the DEX Group. After CPB, patients in both groups had similar hemodynamic responses. CONCLUSIONS: Infusion of dexmedetomidine without bolus seems to be an effective adjuvant to fentanyl on the promotion of sedation and control of hemodynamic responses during surgery for congenital cardiopathies in children.

Keywords

ANALGESIC, Opioids, DRUGS, Adrenergic agonist, PRE-ANESTHETIC MEDICATION, SURGERY, Cardiac

Referências

Rivenes SM, Lewin MB, Stayer SA. Cardiovascular effects of sevoflurane, isoflurane, halothane, and fentanyl-midazolan in children with congenital heart disease: an echocardiographic study of myocardial contractility and hemodynamics. Anesthesiology. 2001;94:223-229.

Gruber EM, Laussen PC, Costa A. Stress response in infants undergoing cardiac surgery: a randomized study of fentanyl bolus, fentanyl infusion, and fentanyl-midazolam infusion. Anesth Analg. 2001;92:882-890.

Gerlach AT, Dasta JF. Dexmedetomidine: an update review. Ann Pharmacother. 2007;41:245-252.

Koroglu A, Demirbilek S, Teksan H. Sedative, haemodynamic and respiratory effects of dexmedetomidine in children undergoing magnetic resonance imaging examination: preliminary results. Br J Anaesth. 2005;94:821-824.

McCutcheon CA, Orme RM, Scott DA. A comparison of dexmedetomidine versus conventional therapy for sedation and hemodynamic control during carotid endarterectomy performed under regional anesthesia. Anesth Analg. 2006;102:668-675.

Arain SR, Ruehlow RM, Uhrich TD. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg. 2004;98:153-158.

Mukhtar AM, Obayah EM, Hassona AM. The use of dexmedetomidine in pediatric cardiac surgery. Anesth Analg. 2006;103:52-56.

Lerman J, Sikich N, Kleinman S. The pharmacology of sevoflurane in infants and children. Anesthesiology. 1994;80:814-824.

Pirat A, Akpek E, Arslan G. Intrathecal versus IV fentanyl in pediatric cardiac anesthesia. Anesth Analg. 2002;95:1207-1214.

Laird TH, Stayer SA, Rivenes SM. Pulmonary-to-systemic blood flow ratio effects of sevoflurane, isoflurane, halothane and fentanyl/midazolam with 100% oxygen in children with congenital heart disease. Anesth Analg. 2002;95:1200-1206.

Koroglu A, Teksan H, Sagir O. A comparison of the sedative, hemodynamic, and respiratory effects of dexmedetomidine and propofol in children undergoing magnetic resonance imaging. Anesth Analg. 2006;103:63-67.

Mason KP, Zurakowski D, Zgleszewski SE. High dose dexmedetomidine as the sole sedative for pediatric MRI. Pediatr Anesth. 2008;18:403-11.

Tosun Z, Akin A, Guler G. Dexmedetomidine-ketamine and propofol-ketamine combinations for anesthesia in spontaneously breathing pediatric patients undergoing cardiac catheterization. J Cardiothorac Vasc Anesth. 2006;20:515-519.

Munro HM, Tirotta CF, Felix DE. Initial experience with dexmedetomidine for diagnostic and interventional cardiac catheterization in children. Pediatr Anesth. 2007;17:109-112.

Shukry M, Kennedy K. Dexmedetomidine as a total intravenous anesthetic in infants. Pediatr Anesth. 2007;17:581-583.

Hammer GB, Drover DR, Cao H. The effects of dexmedetomidine on cardiac electrophysiology in children. Anesth Analg. 2008;106:79-83.

Deutsch E, Tobias JD. Hemodynamic and respiratory changes following dexmedetomidine administration during general anesthesia: sevofluorane vs. desfluorane. Pediatr Anesth. 2007;17:438-444.

Berkenbosh JW, Tobias JD. Development of bradycardia during sedation with dexmedetomidine in an infant concurrently receiving digoxin. Pediatr Crit Care Med. 2003;4:203-205.

Ickeringill M, Shehabi Y, Adamson H. Dexmedetomidine infusion without loading dose in surgical patients requiring mechanical ventilation: haemodynamic effects and efficacy. Anaesth Intensive Care. 2004;32:741-745.

Hammer GB, Philip BM, Schroeder AR. Prolonged infusion of dexmedetomidine for sedation following tracheal resection. Pediatr Anesth. 2005;15:616-620.

Tobias JD, Berkenbosh JW. Sedation during mechanical ventilation in infants and children: dexmedetomidine versus midazolam. South Med J. 2004;97:451-465.

Easley RB, Tobias JD. Pro: dexmedetomidine should be used for infants and children undergoing cardiac surgery. J Cardiothorac Vasc Anesth. 2008;22:147-151.

Ozkose Z, Dermir FS, Pambal K. Hemodynamic and anesthetic advantages of dexmedetomidine an alpha 2-agonist, for surgery in prone position. Tahoku J Exp Med. 2006;210:153-160.

Ramsay MA, Luterman DC. Dexmedetomidine as a total intravenous anesthetic agent. Anesthesiology. 2004;101:787-790.

Rosen DA, Rosen KR. Anomalies of the Aortic Arch and Valve. Pediatric Cardiac Anesthesia. 2005:381-424.

Janke EL, Samra S. Dexmedetomidine and neuroprotection. Semin Anesth Perioper Med Pain. 2006;25:71-76.

Efeitos hemodinâmicos da combinação de dexmedetomidina-fentanil versus midazolam-fentanil em crianças submetidas à cirurgia cardíaca com circulação extracorpórea

Hemodynamic effects of the combination of dexmedetomidine-fentanyl versus midazolam-fentanyl in children undergoing cardiac surgery with cardiopulmonary bypass

Jyrson Guilherme Klamt; Walter Villela de Andrade Vicente; Luis Vicente Garcia; César Augusto Ferreira

Resumo

Palavras-chave

Abstract

Keywords

Referências

Links

Compartilhar

Braz J Anesthesiol