Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942011000500007
Brazilian Journal of Anesthesiology
Scientific Article

Análise retrospectiva de fatores de risco e preditores de complicações intraoperatórias dos bloqueios do neuroeixo realizados na Faculdade de Medicina de Botucatu-UNESP

Retrospective analysis of risk factors and predictors of intraoperative complications in neuraxial blocks at Faculdade de Medicina de Botucatu-UNESP

Ivan Dias Fernandes Pereira; Marcela Miguel Grando; Pedro Thadeu Galvão Vianna; José Reinaldo Cerqueira Braz; Yara Marcondes Machado Castiglia; Luís Antônio Vane; Norma Sueli Pinheiro Módolo; Paulo do Nascimento Júnior; Rosa Beatriz Amorim; Geraldo Rolim Rodrigues Júnior; Leandro Gobbo Braz; Eliana Marisa Ganem

Downloads: 1
Views: 967

Resumo

JUSTIFICATIVA E OBJETIVOS: As alterações cardiovasculares associadas aos bloqueios do neuroeixo apresentam interesse pela frequência com que ocorrem e porque algumas delas podem ser consideradas efeitos fisiológicos desencadeados pelo bloqueio do sistema nervoso simpático. O objetivo desta pesquisa foi avaliar as complicações cardiovasculares intraoperatórias e os fatores preditores associados aos bloqueios do neuroeixo em pacientes com idades > 18 anos submetidos a procedimentos não obstétricos, em um período de 18 anos, em hospital universitário de atendimento terciário-HCFMB-UNESP. MÉTODO: Foi realizada análise retrospectiva das seguintes complicações: hipertensão arterial, hipotensão arterial, bradicardia sinusal e taquicardia sinusal. Tais complicações foram correlacionadas com técnica anestésica, estado físico (ASA), idade, sexo e comorbidades pré-operatórias. Para a análise estatística, foram utilizadas o teste de Tukey para comparações entre proporções e regressão logística. RESULTADOS: Foram avaliados 32.554 pacientes submetidos a bloqueios do neuroeixo e houve 4.109 citações de hipotensão arterial, 1.107 de bradicardia sinusal, 601 de taquicardia sinusal e 466 de hipertensão arterial no período intraoperatório. Hipotensão foi mais frequente nos pacientes submetidos à anestesia subaracnoidea contínua (29,4%, OR = 2,39), com idades > 61 anos e do sexo feminino (OR = 1,27). CONCLUSÕES: Hipotensão e bradicardia intraoperatórias foram complicações mais frequentes, sendo que a hipotensão arterial esteve relacionada à técnica anestésica (ASC), faixa etária elevada e sexo feminino. Taquicardia e hipertensão arterial podem não ter sido diretamente relacionadas aos bloqueios do neuroeixo.

Palavras-chave

CUIDADOS, Intraoperatórios, COMPLICAÇÕES, Intraoperatórias, TÉCNICAS ANESTÉSICAS, Regional, TÉCNICAS ANESTÉSICAS, Regional, SISTEMA CIRCULATÓRIO

Abstract

BACKGROUND AND OBJECTIVES: Cardiovascular changes associated with neuraxial blocks are a cause of concern due to their frequency and because some of them can be considered physiological effects triggered by the sympathetic nervous system blockade. The objective of this study was to evaluate intraoperative cardiovascular complications and predictive factors associated with neuraxial blocks in patients > 18 years of age undergoing non-obstetric procedures over an 18-year period in a tertiary university hospital - HCFMB-UNESP. METHODS: A retrospective analysis of the following complications was undertaken: hypertension, hypotension, sinus bradycardia, and sinus tachycardia. These complications were correlated with anesthetic technique, physical status (ASA), age, gender, and preoperative co-morbidities. The Tukey test for comparisons among proportions and logistic regression was used for statistical analysis. RESULTS: 32,554 patients underwent neuraxial blocks. Intraoperative complications mentioned included hypotension (n = 4,109), sinus bradycardia (n = 1,107), sinus tachycardia (n = 601), and hypertension (n = 466). Hypotension was seen more often in patients undergoing continuous subarachnoid anesthesia (29.4%, OR = 2.39), > 61 years of age, and female (OR = 1.27). CONCLUSIONS: Intraoperative hypotension and bradycardia were the complications observed more often. Hypotension was related to anesthetic technique (CSA), increased age, and female. Tachycardia and hypertension may not have been directly related to neuraxial blocks.

Keywords

Intraoperative Complications, Anesthesia, Epidural, Anesthesia, Spinal, Arrhythmias, Cardiac, Hypotension, Hypertension

References

Carpenter RL, Caplan RA, Brown DL. Incidence and risk factors for side effects of spinal anesthesia. Anesthesiology. 1992;76:906-916.

Mark JB, Steele SM. Cardiovascular effects of spinal anesthesia. Int Anesthesiol Clin. 1989;27:31-39.

Tarkkila PJ, Kaukinen S. Complications during spinal anesthesia: a prospective study. Reg Anesth. 1991;16:101-106.

Curatolo M, Scaramozzino P, Venuti FS. Factors associated with hypotension and bradycardia after epidural blockade. Anesth Analg. 1996;83:1033-1040.

Fanelli G, Casati A, Berti M. Incidence of hypotension and bradycardia during integrated epidural/general anaesthesia: An epidemiologic observational study on 1200 consecutive patients. Italian Study Group on Integrated Anaesthesia.. Minerva Anestesiol. 1998;64:313-319.

Hartmann B, Junger A, Klasen J. The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis with automated data collection. Anesth Analg. 2002;94:1521-1529.

Lesser JB, Sanborn KV, Valskys R. Severe bradycardia during spinal and epidural anesthesia recorded by an anesthesia information management system. Anesthesiology. 2003;99:859-866.

Klasen J, Junger A, Hartmann B. Differing incidences of relevant hypotension with combined spinal-epidural anesthesia and spinal anesthesia. Anesth Analg. 2003;96:1491-1495.

Pollard JB. Cardiac arrest during spinal anesthesia: common mechanisms and strategies for prevention. Anesth Analg. 2001;92:252-256.

Salinas FV, Sueda LA, Liu SS. Physiology of spinal anaesthesia and practical suggestions for successful spinal anaesthesia. Best Pract Res Clin Anaesthesiol. 2003;17:289-303.

Bernards CM. Epidural and Spinal Anesthesia. Clinical Anesthesia. 1996:645-668.

Zar JH. Biostatistical analysis. 1999:516-570.

Tarkkila P, Isola J. A regression model for identifying patients at high risk of hypotension, bradycardia and nausea during spinal anesthesia. Acta Anaesthesiol Scand. 1992;36:554-558.

Hyderally H. Complications of spinal anesthesia. Mt Sinai J Med. 2002;69:55-56.

Casati A, Vinciguerra F. Intrathecal anesthesia. Curr Opin Anaesthesiol. 2002;15:543-551.

Phero JC, Bridenbaugh PO, Edstrom HH. Hypotension in spinal anesthesia: a comparison of isobaric tetracaine with epinephrine and isobaric bupivacaine without epinephrine. Anesth Analg. 1987;66:549-552.

Butterworth J. Physiology of spinal anesthesia: what are the implications for management?. Reg Anesth Pain Med. 1998;23:370-373.

Butterworth JFt, Piccione W Jr, Berrizbeitia LD. Augmentation of venous return by adrenergic agonists during spinal anesthesia. Anesth Analg. 1986;65:612-616.

Butterworth JFt, Austin JC, Johnson MD. Effect of total spinal anesthesia on arterial and venous responses to dopamine and dobutamine. Anesth Analg. 1987;66:209-214.

Rooke GA, Freund PR, Jacobson AF. Hemodynamic response and change in organ blood volume during spinal anesthesia in elderly men with cardiac disease. Anesth Analg. 1997;85:99-105.

Covino BG. Effects of anesthesia. 1985:207-215.

Feldman H cB, Sage D. Direct chronotropic and inotropic effects of local anesthetics agents in isolated guinea pig atria. Regional Anesthesia. 1982;7:149-156.

Eisenach JC, De Kock M, Klimscha W. Alpha(2)-adrenergic agonists for regional anesthesia: A clinical review of clonidine (1984-1995). Anesthesiology. 1996;85:655-674.

Favarel-Guarrigues JF, Sztark F, Petidjean ME. Hemodynamic effects of spinal anesthesia in elderly: single dose versus titration through a catheter. Anesth Analg. 1996;82:312-316.

Klimscha W, Weinstabl C, Ilias W. Continuous spinal anesthesia with a microcatheter and low-dose bupivacaine decreases the hemodynamic effects of centroneuraxis blocks in elderly patients. Anesth Analg. 1993;77:275-280.

Schnider TW, Mueller-Duysing S, Johr M. Incremental dosing versus single-dose spinal anesthesia and hemodynamic stability. Anesth Analg. 1993;77:1174-1178.

Wilhelm S, Standl T, Burmeister M. Comparison of continuous spinal with combined spinal-epidural anesthesia using plain bupivacaine 0.5% in trauma patients. Anesth Analg. 1997;85:69-74.

Collard CD, Eappen S, Lynch EP. Continuous spinal anesthesia with invasive hemodynamic monitoring for surgical repair of the hip in two patients with severe aortic stenosis. Anesth Analg. 1995;81:195-198.

Veering BT. Hemodynamic effects of central neural blockade in elderly patients. Can J Anaesth. 2006;53:117-121.

Critchley LA. Hypotension, subarachnoid block and the elderly patient. Anaesthesia. 1996;51:1139-1143.

Racle JP, Poy JY, Haberer JP. A comparison of cardiovascular responses of normotensive and hypertensive elderly patients following bupivacaine spinal anesthesia. Reg Anesth. 1989;14:66-71.

Youngs PJ, Littleford J. Arrhythmias during spinal anesthesia. Can J Anaesth. 2000;47:385-390.

Watkins EJ, Dresner M, Calow CE. Severe vasovagal attack during regional anaesthesia for caesarean section. Br J Anaesth. 2000;84:118-120.

Kreutz JM, Mazuzan JE. Sudden asystole in a marathon runner: the athletic heart syndrome and its anesthetic implications. Anesthesiology. 1990;73:1266-1268.

Geffin B, Shapiro L. Sinus bradycardia and asystole during spinal and epidural anesthesia: a report of 13 cases. J Clin Anesth. 1998;10:278-285.

Lovstad RZ, Granhus G, Hetland S. Bradycardia and asystolic cardiac arrest during spinal anaesthesia: a report of five cases. Acta Anaesthesiol Scand. 2000;44:48-52.

Mackey DC, Carpenter RL, Thompson GE. Bradycardia and asystole during spinal anesthesia: a report of three cases without morbidity. Anesthesiology. 1989;70:866-868.

Carpenter RL, Hogan QH, Liu SS. Lumbosacral cerebrospinal fluid volume is the primary determinant of sensory block extent and duration during spinal anesthesia. Anesthesiology. 1998;89:24-29.

Jacobsen J, Sofelt S, Brocks V. Reduced left ventricular diameters at onset of bradycardia during epidural anaesthesia. Acta Anaesthesiol Scand. 1992;36:831-836.

Caplan RA, Ward RJ, Posner K. Unexpected cardiac arrest during spinal anesthesia: a closed claims analysis of predisposing factors. Anesthesiology. 1988;68:5-11.

Auroy Y, Narchi P, Messiah A. Serious complications related to regional anesthesia: results of a prospective survey in France. Anesthesiology. 1997;87:479-486.

Bradford EM. Haemodynamic changes associated with the application of lower limb tourniquets. Anaesthesia. 1969;24:190-197.

Scavone BM, Ratliff J, Wong CA. Physiologic Effects of Neuraxial Anesthesia. Spinal and Epidural Anesthesia. 2007:111-126.

5dd6a02c0e8825052413f286 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections