Uso de dexmedetomidina em pacientes obesos mórbidos submetidos a gastroplastia: estabilidade cardiovascular e consumo de anestésicos venosos. Estudo retrospectivo

Abstract

BACKGROUND AND OBJECTIVES: The administration of powerful and short duration anesthetic agents is essential for patients undergoing bariatric surgical procedure. The dexmedetomidine, an α 2-adrenergic agonist, has appeared as an adjuvant option of the venous anesthesia technique. This study aimed at assessing the efficacy of dexmedetomidine associated with the venous anesthesia in morbid obese patients undergoing gastroplasty procedures. METHODS: Retrospective analysis of morbid obese patients undergone open bariatric surgical intervention under anesthesia with propofol and alfentanil, with or without dexmedetomidine. Patients were allocated into two groups: Control (propofol and alfentanil) and Dexmedetomidine (propofol, alfentanil and dexmedetomidine). For both groups, the anesthetic maintenance was as follows: propofol = 0.075 to 0.1 mg.kg -1.min -1 and alfentanil = 0.75 to 1 μg.kg -1.min -1; in the dexmedetomidine (DMD) group, initial dose of 1 μg.kg -1 in 10 min and maintenance with 0.4 to 0.7 μg.kg -1.h -1. The variables studied were: age, gender, body mass index (BMI), surgical time and recovery time, heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), hemoglobin peripheral saturation (SpO 2), propofol and alfentanil consumption and side effects. RESULTS: The dexmedetomidine group has shown a significant reduction in propofol and alfentanil consumption. The heart rate presented a significant variation only in the dexmedetomidine group. Both SPB and DBP presented a statistically significant reduction in both groups for the first 20 minutes, and subsequent stabilization. No side effects were observed in both groups of patients. CONCLUSIONS: This study has shown the efficacy of dexmedetomidine administration in combination with venous anesthesia with propofol and alfentanil, thus promoting reduction in venous anesthetic drugs consumption, cardiovascular stability and time to recovery similar to that of the technique without dexmedetomidine. No side effects were noted associated with the use of dexmedetomidine. © Sociedade Brasileira de Anestesiologia, 2006.