Nunes Rogean Rodrigues, Nora Fernando Squeff, Dumaresq Danielle Maia Holanda, Cavalcante Rute Maria Araújo, Costa Amanda Antunes, Carneiro Lara Moreira Mendes, Alencar Julio Cesar Garcia de, Cardoso Flávia Pereira Fernandes
Hospital São Carlos, Fortaleza, CE, Brazil.
Rev Bras Anestesiol. 2012 Jul;62(4):484-501. doi: 10.1016/S0034-7094(12)70147-2.
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.
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.
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.
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.
近期研究已将术后死亡率与麻醉死亡率相关联，尤其是与麻醉深度和收缩压（SBP）相关。本研究的目的是评估在腹腔镜手术期间，使用瑞芬太尼和丙泊酚进行全凭静脉麻醉（TIVA）并通过反应熵（RE）监测时，麻醉深度对氧化应激标志物（硫代巴比妥酸反应物和谷胱甘肽）血药浓度的影响。
20例美国麻醉医师协会（ASA）分级为I级、体重指数（BMI）为20 - 26 kg·m⁻²、年龄在20至40岁之间的成年患者被随机分为两组：第一组在麻醉 - 手术过程中维持RE在45至59之间，第二组在麻醉 - 手术过程中维持RE在30至44之间。在两组中，瑞芬太尼和丙泊酚输注均由效应室（Es）控制，根据需要调整以维持RE的目标值（第一组和第二组），并始终评估抑制率（SR）。在六个时间段对患者进行评估：M1（麻醉前即刻）、M2（气管插管[TI]前）、M3（TI后5分钟）、M4（气腹[PPT]前即刻）、M5（PPT后1分钟）和M6（术后1小时）。在所有时间点评估以下参数：SBP、舒张压（DBP）、心率（HR）、RE、SR、硫代巴比妥酸反应物和谷胱甘肽。
我们发现第一组和第二组在M5时硫代巴比妥酸反应物和谷胱甘肽均升高（p<0.05），第二组的值更高，并且在PPT后即刻，第二组有3例患者的SR升高。
第一组（M5）中标志物升高表明内脏循环中无氧代谢（AM）增加，而第二组中观察到的最高值（M5时GII > GI，p<0.05%）表明另一个因素（深度麻醉）对AM增加有影响，这可能是由于自主神经系统抑制增加和内脏自我调节减弱所致。
