Análise retrospectiva de fatores de risco e preditores de complicações intraoperatórias dos bloqueios do neuroeixo realizados na 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

doi:10.1590/S0034-70942011000500007

Artigo Científico

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

http://dx.doi.org/10.1590/S0034-70942011000500007 Braz J Anesthesiol, vol.61, n5, p.574-581, 2011

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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

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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

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