Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942012000400002
Brazilian Journal of Anesthesiology
Scientific Article

Influência da anestesia venosa total, entropia e laparoscopia sobre o estresse oxidativo

Influence of total intravenous anesthesia, entropy and laparoscopy on oxidative stress

Rogean Rodrigues Nunes; Fernando Squeff Nora; Danielle Maia Holanda Dumaresq; Rute Maria Araújo Cavalcante; Amanda Antunes Costa; Lara Moreira Mendes Carneiro; Julio Cesar Garcia de Alencar; Flávia Pereira Fernandes Cardoso

http://dx.doi.org/10.1590/S0034-70942012000400002 Braz J Anesthesiol, vol.62, n4, p.492-501, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: Estudos recentes correlacionam mortalidade pós-operatória e anestésica, especialmente a profundidade anestésica e pressão arterial sistólica (PAS). O objetivo deste estudo foi avaliar os efeitos da profundidade da anestesia venosa total (AVT) realizada com remifentanil e propofol com monitoração da entropia de resposta (RE) sobre as concentrações sanguíneas dos marcadores do estresse oxidativo: TBARS e glutationa, durante operações pelo acesso vídeolaparoscópico. MÉTODO: Vinte pacientes adultas, ASA I, IMC 20-26 kg.m-2, idades entre 20 e 40 anos, foram aleatoriamente distribuidas em dois grupos iguais: Grupo I - submetidas a procedimento anestésico-cirúrgico com RE mantida entre 45 e 59 e Grupo II - submetidas a procedimento anestésico-cirúrgico com RE entre 30 e 44. Em ambos os grupos, a infusão de remifentanil e propofol foi controlada pelo sitio efetor (Se), ajustados para manter RE nos valores desejados (Grupos I e II) e avaliando-se sempre a taxa de supressão (TS). As pacientes foram avaliadas em seis momentos: M1(imediatamente antes da indução anestésica), M2 (antes da intubação traqueal [IT]), M3 (5 minutos após IT), M4 (imediatamente antes do pneumoperitônio-PPT), M5 (1 minuto após o PPT) e M6 (uma hora após a operação). Em todos os momentos foram avaliados os seguintes parâmetros: PAS, PAD, FC, RE, TS, TBARS e glutationa. RESULTADOS: Observaram-se aumentos no TBARS e glutationa em M5, tanto no Grupo I como no Grupo II (p < 0,05), com maiores valores no Grupo II. TS em três pacientes no Grupo II, imediatamente após PPT. CONCLUSÕES: A elevação dos marcadores no Grupo I (em M5) sugere aumento do metabolismo anaeróbico (MA) na circulação esplâncnica enquanto os valores mais elevados observados no Grupo II (GII > GI em M5 - p < 0,05%) sugerem interferência de mais um fator (anestesia profunda), como responsável pelo aumento no MA, provavelmente como resultados de maior depressão do sistema nervoso autônomo e menor autorregulação esplâncnica.

Palavras-chave

ANESTESIA, Venosa, CIRURGIA, Entropia, Estresse Oxidativo, Videolaparoscópica

Abstract

BACKGROUND AND OBJECTIVES: Recent studies have correlated postoperative mortality with anesthetic mortality, especially with the depth of anesthesia and systolic blood pressure (SBP). The aim of this study is to evaluate the effects of the depth of total intravenous anesthesia (TIVA) using remifentanil and propofol, performed with monitoring of response entropy (RE) on blood concentrations of oxidative stress markers (TBARS and glutathione) during laparoscopic operations. METHOD: Twenty adult patients, ASA I, BMI 20-26 kg.m-2, aged 20 to 40 years, were randomly distributed into two groups: Group I underwent anesthetic-surgical procedure with RE maintained between 45 and 59, and Group II underwent anesthetic-surgical procedure with RE between 30 and 44. In both groups, the remifentanil and propofol infusion was controlled by the effector site (Es), adjusted to maintain RE desired values (Groups I and II) and always assessing the suppression rate (SR). Patients were evaluated in six periods: M1 (immediately before anesthesia), M2 (before tracheal intubation [TI]), M3 (5-minutes after TI), M4 (immediately before pneumoperitoneum [PPT]), M5 (1-minute after PPT), and M6 (1-hour after the operation). The following parameters were assessed at all times: SBP, DBP, HR, RE, SR, TBARS, and glutathione. RESULTS: We found increases in TBARS and glutathione in M5, both in Group I and Group II (p < 0.05), with higher values in Group II, and SR in three patients in Group II, immediately after PPT. CONCLUSIONS: Increased markers in Group I (M5) suggests an increase in anaerobic metabolism (AM) in the splanchnic circulation while the highest values seen in Group II (GII > GI in M5, p < 0.05%) suggest interference of another factor (deep anesthesia) responsible for the increase in AM, probably as a result of increased autonomic nervous system depression and minor splanchnic self-regulation.

Keywords

Entropy, Intravenous Anesthesia, Laparoscopy, Oxidative Stress

Referencias

Sherwood ER, Toliver-kinsky T. Mechanisms of the inflammatory response. Best Pract Res Clin Anaesthesiol. 2004;18:305-405.

Fink MP. O papel das citocinas como mediadores da resposta inflamatória. Sabiston: Tratado de Cirurgia. 2005:45-66.

Weigand MA, Horner C, Bardenheuer HJ, Bouchon A. The systemic inflammatory response syndrome. Best Pract Res Clin Anaesthesiol. 2004;18:455-475.

Wilson JX, Gelb AW. Free radicals, antioxidants, and neurologic injury: possible relationship to cerebral protetion by anesthetics. J Neurosurg Anesthesiol. 2002;14:66-79.

Ferreira ALA, Matsubara LS. Radicais livres: conceitos, doenças relacionadas, sistema de defesa e estresse oxidativo. Rev Ass Med Br. 1997;43:61-68.

Aldemir O, Celebi C, Cevik K, Duzung E. The effects of propofol on free radical prodution after tournequet induced ischaemia-reperfusion injury during knee arthroplasty. Acta Anaesthesiol Scand. 2001;45:1221-1225.

Shannon CE. A mathematical theory of communication. Bell Syst Tech J. 1948;27:379-423.

Viertïo-oja H, Maja V, Särkela M. Description of the entropyTM algorithm as applied in the datex-ohmeda s/5TM entropy module. Acta Anaesthesiol Scand. 2004;48:154-161.

Bein B. Entropy. Best Pract Res Clin Anaesthesiol. 2006;20:101-109.

Nunes RR, Cavalcante SL. Influência do bloqueio neuromuscular despolarizante nas entropias. São Paulo Med J. 2007:125-126.

Fleisher LA, Anderson GF. Perioperative risk: How can we study the influence of provider characteristics?. Anesthesiology. 2002;96:1039-1041.

Arbous MS, Grobbee DE, van Kleef JW. Mortality associated with anaesthesia: A qualitative analysis to identify risk factors. Anaesthesia. 2001;56:1141-1153.

Rasmussen LS, Johnson T, Kuipers HM. Does anaesthesia cause postoperative cognitive dysfunction?: A randomized study of regional versus general anaesthesia. Acta Anaesthesiol Scand. 2003;47:260-266.

Glass PS, Bloom M, Kearse L. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology. 1997;86:836-847.

Buhre W, Rossaint R. Perioperative management and monitoring in anesthesia. Lancet. 1997;362:1839-1846.

Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005;100:4-10.

Lindholm ML, Träff S, Granath F. Mortality within 2 years after surgery in relation to low intraoperative bispectral index values and preexisting malignant disease. Anesth Analg. 2009;108:508-512.

Leslie K, Myles PS, Forbes A. The effect of bispectral index monitoring on long-term survival in the B-ware trial. Anesth Analg. 2010;110:816-822.

Myles PS, Daly D, Silver A, Chan MTV. Prediction of neurological outcome using bispectral monitoring in patients with severe ischemic-hypoxic brain injury during emergency surgery. Anesthesiology. 2009;110:1106-1115.

Guignard B, Cost C, Menigaux C, Chauvin M. Reduced isoflurane consumption with bispectral index monitoring. Acta Anaesthesiol Scand. 2001;45:308-314.

Katoh T, Sato S. Influence of age on hypnotic requeriment, bispectral index, and 95% spectral edge frequency associated with sedation induced by isoflurane. Anesthesiology. 2000;92:55-61.

Nunes RR. Componentes da atividade anestésica: uma nova visão. Rev Bras Anestesiol. 2003;53:145-149.

Nunes RR, Almeida MP, Sleigh JW. Entropia espectral: um novo método para adequação anestésica. Rev Bras Anestesiol. 2004;54:404-422.

Kudoh A, Katagai H, Takazawa T, Matsuki A. Plasma proinflammatory cytokine response to surgical stress in elderly patients. Cytokine. 2001;15:270-273.

Glantzounis GK, Tselepis AD, Tambaki AP. Laparoscopic surgery-induced changes in oxidative stress markers in human plasma. Surg Endosc. 2001;15:1315-1319.

Leung KL, lai PBS, Ho RLK. Systemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma. Ann Surg. 2000;231:506-511.

Schwenk W, Jacobi C, Mansmann U, Böhn B, Müller JM. Inflammatory response after laparoscopic and conventional colorectal resections: results of a prospective randomized trial. Langenbeck's Archives Surgery. 2000;385:2-9.

Gerges FJ, Kanazi GE, Jabbour-khoury SI. Anesthesia for laparoscopy: a review. J Clin Anesth. 2006;18:67-78.

Gutt CN, Oniu T, Mehrabi A. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg. 2004;21:95-105.

Morgan JR GE, Mikhail MS, Murray MJ. Clinical Anesthesia. 2006:725-741.

Schilling MK, Redaelli C, Signer C. Splanchnic microcirculatory change during CO2 laparoscopy. J Am Coll Surg. 1997;184:378-382.

Schafer M, Sagesser H, Reichen J. Alterations in hemodynamics and hepatic and splanchnic circulation during laparoscopy in rats. Surg Endosc. 2001;15:1197-1201.

Koivusalo AM, Kellokumpu I, Ritkari S. Splanchnic and renal deterioration during and after laparoscopic cholecystectomy: a comparison of the carbon dioxide pneumoperitoneum and the abdominal wall lift method. Anesth Analg. 1997;85:886-891.

Ishizaki Y, Bandai Y, Shimomura K. Changes in splanchnic blood flow and cardiovascular effects following peritoneal insufflation of carbon dioxide. Surg Endosc. 2004;7:420-423.

Bendet N, Morozov V, Lavi R. Does laparoscopic cholecystectomy influence peri-sinusoidal cell activity?. Hepatogastroenterology. 1999;46:1603-1606.

Shimogai M, Iranami H, Yamazaki A. Transient but profound reduction of bispectral index values after tourniquet deflation: did the BIS detect an alteration of brain electrocortical activity?. Anesth Analg. 2006;103:1613-1614.

Dewar D, Underhill SM, Goldberg MP. Oligodendrocytes and ischemic brain Injury. Journal of Cerebral Blood Flow & Metabolism. 2003;23:263-274.

Juurlink BH, Thorburne SK, Hertz L. Peroxide-scavenging deficit underlies oligodendrocyte susceptibility to oxidative stress. Glia. 1998;22:371-378.

Thorburne SK, Juurlink BH. Low glutathione and high iron govern the susceptibility of oligodendroglial precursors to oxidative stress. J Neurochem. 1996;67:1014-1022.

Seagard JL, Hopp FA, Bosnjak ZJ. Sympathetic efferent nerve activity in conscious and isoflurane-anesthetized dogs. Anesthesiology. 1984;61:266-270.

Seagard JL, Hopp FA, Donegan JH. Halotane and the carotid sinus reflex: evidence for multiple sites of action. Anesthesiology. 1982;57:191-202.

Muzi M, Ebert TJ. A randomized, prospective comparison of halothane, isoflurane and enflurane on baroreflex control of heart rate in humans. Adv Pharmacol. 1994;31:379-87.

Kotrly KJ, Ebert TJ, Vucins EJ. Human baroreceptor control of heart rate under isoflurane anesthesia. Anesthesiology. 1984;60:173-179.

Tanaka M, Nishikawa T. Arterial baroreflex function in humans anaesthetized with sevoflurane. Br J Anaesth. 1999;82:350-354.

Ebert T, Muzi M, Lopatka C. Neurocirculatory responses to sevoflurane in humans: a comparison to desflurane. Anesthesiology. 1995;83:88-95.

Ebert TJ, Kotrly KJ, Madsen KS. Fentanyl-diazepam anesthesia with or without N2O does not attenuate cardiopulmonary baroreflex-mediated vasoconstrictor responses to controlled hypovolemia in humans. Anesth Analg. 1988;67:548-554.

Kotrly KJ, Ebert TJ, Vucins EJ. Effects of fentanyl-diazepam-nitrous oxide anaesthesia on arterial baroreflex control of heart rate in man. Br J Anaesth. 1986;58:406-414.

Olshan AR, O'connor DT, Cohen IM. Baroreflex dysfunction in patients with adult-onset diabetes and hypertension. Am J Med. 1983;74:233-242.

Gribbin B, Pickering TG, Sleight P. Effect of age and high blood pressure on baroreflex sensitivity in man. Circulation Research. 1971;29:424-431.

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