Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942013000100011
Brazilian Journal of Anesthesiology
Review Article

Anestésicos, precondicionamento e proteção cerebral

Anesthetics, cerebral protection and preconditioning

Rogean Rodrigues Nunes; Gastão Fernandes Duval Neto; Júlio César Garcia de Alencar; Suyane Benevides Franco; Nayanna Quezado de Andrade; Danielle Maia Holanda Dumaresq; Sara Lúcia Cavalcante

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Resumo

JUSTIFICATIVA E OBJETIVOS: Diversos estudos têm demonstrado o precondicionamento cerebral como mecanismo protetor diante de uma situação de estresse. Fatores determinantes são descritos, bem como a neuroproteção proporcionada por agentes anestésicos e não anestésicos. CONTEÚDO: Fez-se revisão baseada nos principais artigos da literatura que englobam a fisiopatologia da isquemia-reperfusão e lesão neuronal e os fatores não farmacológicos (inflamação, glicemia e temperatura) e farmacológicos relacionados com a mudança da resposta à isquemia-reperfusão, além da neuroproteção induzida pelo uso dos anestésicos. CONCLUSÕES: O cérebro tem a capacidade de se proteger contra a isquemia quando estimulado. A elucidação desse mecanismo possibilita a aplicação de substâncias indutoras do precondicionamento, como alguns anestésicos, outros fármacos e medidas não farmacológicas, como a hipotermia, com o objetivo de induzir tolerância a lesões isquêmicas.

Palavras-chave

ANESTÉSICOS, COMPLICAÇÕES, Isquemia, HIPOTERMIA, Precondicionamento Isquêmico, SISTEMA NERVOSO CENTRAL

Abstract

BACKGROUND AND OBJECTIVES: Several studies demonstrate that cerebral preconditioning is a protective mechanism against a stressful situation. Preconditioning determinants are described, as well as the neuroprotection provided by anesthetic and non-anesthetics agents. CONTENT: Review based on the main articles addressing the pathophysiology of ischemia-reperfusion and neuronal injury and pharmacological and non-pharmacological factors (inflammation, glycemia, and temperature) related to the change in response to ischemia-reperfusion, in addition to neuroprotection induced by anesthetic use. CONCLUSIONS: The brain has the ability to protect itself against ischemia when stimulated. The elucidation of this mechanism enables the application of preconditioning inducing substances (some anesthetics), other drugs, and non-pharmacological measures, such as hypothermia, aimed at inducing tolerance to ischemic lesions.

Keywords

Ischemic Preconditioning, Ischemia, Central Nervous System, Anesthetics, Hypothermia

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