Tabagismo e efeito de dexmedetomidina e fentanil na intubação traqueal

Kemal Gulsoy; Serpil Deren; Semih Baskan; Dilsen Ornek; Bayazit Dikmen

doi:10.1590/S0034-70942012000200002

Scientific Article

Tabagismo e efeito de dexmedetomidina e fentanil na intubação traqueal

Cigarette smoking and the effect of dexmedetomidine and fentanyl on tracheal intubation

Kemal Gulsoy; Serpil Deren; Semih Baskan; Dilsen Ornek; Bayazit Dikmen

http://dx.doi.org/10.1590/S0034-70942012000200002 Braz J Anesthesiol, vol.62, n2, p.147-153, 2012

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Resumo

JUSTIFICATIVA E OBJETIVOS: Comparar os efeitos de dexmedetomidina e fentanil sobre as alterações hemodinâmicas em fumantes crônicos do sexo masculino. MÉTODOS: Este é um estudo prospectivo, randômico e cego. Sessenta pacientes do sexo masculino, tabagistas crônicos, com idades entre 16 e 60 anos foram selecionados. Os pacientes foram alocados aleatoriamente em dois grupos: Grupo D (n = 30) recebeu 1 µg.kg-1 de dexmedetomidina e Grupo F (n = 30) recebeu 3 µg.kg-1 de fentanil em 150 mL de solução salina normal, com início 10 minutos antes da indução da anestesia. Antes da intubação, a frequência cardíaca e a pressão arterial dos pacientes foram medidas. Após a indução da anestesia para intubação endotraqueal, a frequência cardíaca e os valores da pressão arterial foram novamente medidos 1, 3 e 5 minutos após a intubação. RESULTADOS: A frequência cardíaca estava baixa no Grupo D antes da indução da anestesia, intubação e no primeiro e terceiro minutos pósintubação. A pressão arterial sistólica estava baixa no Grupo F antes da intubação. Embora a pressão arterial diastólica estivesse menor antes da indução da anestesia e aos 5 minutos após a intubação em ambos os grupos, ela já estava baixa no Grupo F antes mesmo da intubação. Enquanto a pressão arterial média estava baixa no Grupo D antes da indução anestésica, ela estava baixa no Grupo F antes da intubação. Os valores para o duplo produto (frequência cardíaca vezes pressão arterial sistólica) estavam baixos no Grupo D antes da indução e no 1º e 3º minutos após a intubação. CONCLUSÕES: A dexmedetomidina, aplicada em fumantes crônicos do sexo masculino via infusão a uma dose de 1 µg.kg-1 10 minutos antes de indução anestésica, controla melhor as elevações da frequência cardíaca e do duplo produto a 1 e 3 minutos após a intubação, comparado ao grupo que recebeu 3 µg.kg-1 de fentanil.

Palavras-chave

ANALGÉSICOS, Tabagismo, COMPLICAÇÕES, INTUBAÇÃO TRAQUEAL, MONITORAÇÃO, ANALGÉSICOS, Tabaquismo, COMPLICACIONES, INTUBACIÓN TRAQUEAL, MONITORACIÓ

Abstract

BACKGROUND AND OBJECTIVES: To compare the effect of dexmedetomidine and fentanyl on hemodynamic changes in chronic male smokers. METHODS: This is a prospective, randomized, blinded study. Were selected 60 chronic male smokers (aged 16 to 60 years). The patients were randomly divided into two groups: Group D (n = 30) received 1 µg.kg-1 dexmedetomidine and Group F (n = 30) received 3 µg.kg-1 fentanyl in 150 mL of normal saline, beginning 10 minutes before anesthesia induction. Before intubation, the heart rate and blood pressure of patients were measured. After anesthesia induction for endotracheal intubation, heart rate and blood pressure values were measured at 1, 3, and 5 minutes after intubation. RESULTS: Heart rate was low in Group D before anesthesia induction, intubation, and at the 1st and 3rd minutes after intubation. Systolic arterial pressure was low in Group F before intubation. Although diastolic arterial pressure was lower before anesthesia induction and at 5 minutes after intubation in both groups, it was already low in Group F before intubation. Whereas the mean arterial pressure was low in Group D before anesthesia induction, it was low in Group F before intubation. The values for rate-pressure product were low in Group D before induction and at 1 and 3 minutes after intubation. CONCLUSIONS: Dexmedetomidine, which was applied via infusion at a loading dose of 1 µg.kg-1 10 minutes before anesthesia induction in chronic male smokers, better suppressed increases in heart rate and rate-pressure product at 1 and 3 minutes after intubation compared to the group receiving 3 µg.kg-1 fentanyl.

Keywords

Dexmedetomidine, Hemodynamics, Intratracheal intubation, Monitoring, Intraoperative, Smoking

Referências

Grassi G, Seravalle G, Calhoun DA. Mechanisms responsible for sympathetic activation by cigarette smoking in humans. Circulation. 1994;90:248-253.

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

Shribman AJ, Smith G, Achola KJ. Cardiovascular and catecholamine responses to laryngoscopy with and without tracheal intubation. Br J Anaesth. 1987;59:295-299.

Finfer SR, MacKenzie SI, Saddler JM, Watkins TG. Cardiovascular responses to tracheal intubation: a comparison of direct laryngoscopy and fiberoptic intubation. Anaesth Intensive Care. 1989;17:44-48.

Bishop MJ, Harrington RM, Tencer AF. Force applied during tracheal intubation. Anesth Analg. 1992;74:411-414.

Slogoff S, Keats AS. Does perioperative myocardial ischemia lead to postoperative myocardial infarction?. Anesthesiology. 1985;62:107-114.

Jee D, Moon HL. Gender may affect the hemodynamic response to induction and intubation in young adults. J Clin Anesth. 2003;16:563-567.

Che S. Actions of nicotine and smoking on circulation. Pharmacol Ther. 1982;17:129-1.

Groppelli A, Giorgi DMA, Omboni S, Parati G, Mancina G. Persitent blood pressure increase induced by heavy smoking. J.Hypertens. 1992;10:495-499.

Baer L, Radichevich I. Cigarette smoking in hypertensive patients. Am J Med. 1985;78:564-568.

Trap-Jensen L, Carlen JE, Svensen TL, Christensen NS. Cardiovascular and adrenergic effects of smoking during immediate non-selective beta-adrenoreceptor blockade in hummans. Eur J.Clin Invest. 1979;9:181-183.

Trap-Jensen J. Effects of smoking on the heart and peripheral circulation. Am Heart J. 1988;115:258-263.

Winniford MD. Smoking and cardiovascular function. J Hypertens. 1990;9(^s5):17-23.

Groppelli A, Giorgi DMA, Omboni S, Parati G, Mancina G. Blood pressure and heart rate response to repeated smoking before and after betablockade and selective alpha 1-inhibation function. J Hyper-tens. 1990;8(^s5):35-40.

Laxton CH, Milner Q, Murphy PJ. Haemodynamic changes after tracheal intubation in cigarette smokers compared with non-smokers. Br J Anaesth. 1999;82(3):442-443.

Erskine RJ, Murphy PJ, Langton JA. Sensitivity of upper airway reflexes in cigarette smokers: effect of abstinence. Br J Anaesth. 1994;73:298-302.

Fitz-Henry J, Curran J, Griffiths D. Smokers and haemodynamic response to desflurane. Anaesthesia. 1999;54:800-803.

McBride PE. The health consequences of smoking-cardiovascular disease. Med Clin North Am. 1992;76:333-353.

Cuvas O, Er A, Ikeda OC, Dikmen B, Ba ar H. Cigarette smoking and the haemodynamic response to tracheal intubation. Anaesthesia. 2008:1365-2004.

Jaakola ML, Kanto J, Scheinin H, Kallio A. Intramuscular dexmedetomidine premedication: an alternative to midazolam-fentanylcombination in elective hysterectomy?. Acta Anaesthesiol Scand. 1994;38:238-243.

Jaakola ML. Dexmedetomidine premedication before intravenous regional anesthesia in minor outpatient hand surgery. J Clin Anesth. 1994;6:204-211.

Feld JM, Hoffman WE, Stechert MM, Hoffman IW, Ananda RC. Fentanyl or dexmedetomidine combined with desflurane for bariatric surgery. J Clin Anesth. 2006;18:24-28.

Hofer RE, Sprung J, Sarr MG, Wedel DJ. Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics. Can J Anaesth. 2005;52:176-180.

Paris A, Tonner PH. Dexmedetomidine in anaesthesia. Curr Opin Anaesthesiol. 2005;18:412-418.

Ebert TJ, Hall JE, Barney JA, Uhrich TD, Colinco MD. The effects of increasing plasma concentrations of dexmedetomidine in humans. Anaesthesiology. 2000;93:382-394.

Flacke JW. α2-adrenergic agonists in cardiovascularanesthesia. J Cardiothorac Vasc Anesth. 1992;6:344-359.

Chen DG, Dai XZ, Zimmerman BG, Bache RJ. Postsynaptic α1 and α2 - adrenergic mechanism in coronary vazoconstruction. J Cardiovasc Pharmacol. 1988;11:61-67.

Lawrence CJ, De Lange S. Effects of a single perioperative dexmedetomidine dose on isoflurane requiretmens and perioperative haemodynamic stability. Anaesthesia. 1997;52:736-744.

Xu H, Aibiki M, Seki K, Ogura S, Ogli K. Effects of dexmedetomidine, an α2 adrenoceptor agonist,on renal sympathetic nerve activity,blood pressure,heart rate and central venous pressure in urethane-anesthetized rabbits. J Auton Nerv Syst. 1998;71:48-54.

Özköse Z, Demir FS, Pampal K, Yardım S. Hemodynamic and anesthetic advantages of dexmedetomidine, α2 agonist for surgey in prone position. Tohoku J Exp Med. 2006;210:153-160.

Saliho lu Z, Demiroluk S, Demirkiran, Kose Y. Comparison of effects of remifentanil, alfentanil and fentanyl on cardiovascular responses to tracheal intubation inmorbidly obese patients. Eur J Anaesthesiol. 2002;19(2):125-128.

Aantaa RE, Kanto JH, Scheinin M, Kallio AMI, Scheinin H. Dexmedetomidine Premedication for Minor Gynecologic Surgery. Anesth Analg. 1990;70:407-413.

Aho M, Scheinin M, Lehtinen AM, Erkola O, Vuorinen J, Korttila K. Intramuscularly administered dexmede tomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy. Anesth Analg. 1992;75:932-999.

Willigers HM, Prinzen FW, Roekaerts HJ. Comparison of the effects of dexmedetomidine and esmolol on myocardial oxygen consumption in dogs. E J A. 2004;21(12):957-966.

Kayhan Z. Kardiyovasküler Sistem ve Anestezi: Klinik Anestezi. 2004:308-10.

Gobel FL, Norstrom LA, Nelson RR. The rate-pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris. Circulation. 1978;57(3):549-556.

Kaplan JD, Schuster DP. Physigolic consequences of tracheal intubation. Clınics in Chest Medicine. 1991;12(3):425-432.

Willigers HM, Prinzen FW, Roekaerts PMHJ. The Effects of esmolol and dexmedetomidine on myocardial oxygen consumption during sympathetic stimulation in dogs. J Cardiothorac Vasc Anesth. 2006;20(3):364-370.

Hoeft A, Sonntag H, Stephan H, Kettler D. Validation of myocardial oxygen demand indices in patients awake and during anesthesia. Anaesthesiology. 1991;75:48-56.

Katoh T, Nakajima Y, Moriwaki G. Sevoflurane requiretments for tracheal intubation with and without fentanyl. Br J Anaesth. 1999;82(4):561-565.

Sear JW. Recent advances and developments in the clinical use of iv opioids during the peroperative period. Br.J.Anesth. 1998;81:38-50.

Chung F, Evans D. Low-dose fentanyl: Haemodynamic response during induction and intubation in geriatric patients. Can Anaesth Soc J. 1985;32:622-628.

Adachi YU, Satomoto M, Higuchi H, Watanabe K. Fentanyl attenuates the hemodynamic response to endotracheal intubation more than the response to laryngoscopy. Anest. Analg. 2002;95(1):233-237.

Iyer V, Russell W. Induction using fentanyl to suppress the intubation response in the cardiac patient: what is the optimaldose?. Anaesth Intens Care. 1988;16:411-417.

Tabagismo e efeito de dexmedetomidina e fentanil na intubação traqueal

Cigarette smoking and the effect of dexmedetomidine and fentanyl on tracheal intubation

Kemal Gulsoy; Serpil Deren; Semih Baskan; Dilsen Ornek; Bayazit Dikmen

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