SUMMARY OBJECTIVES.To evaluate the hemodynamic responses to nociceptive stimuli in children submitted to videolaparoscopic appendectomy under balanced anesthesia with isoflurane and dexmedetomidine. METHODS. Randomized, double-blind and placebo-controlled study involving 26 children submitted to videolaparoscopic appendectomy carried out at Hospital São Lucas (PUCRS) between May 2004 and February 2005. Patients were assigned to two groups: (a) Dexmedetomidine group (n=13): infusion of 1μg/kg over 10 minutes and maintenance dose of 0.5μg/kg/ h) as an adjuvant to inhaled isoflurane anesthesia; (b) Control group (n=13): normal saline infusion at a similar rate and volume of the dexmedetomidine infusion. During the different surgical and anesthetic periods, groups were compared regarding heart rate, systolic and diastolic arterial blood pressures as well as need of supplemental fentanyl infusion. Student's t test, ANOVA, and Finner's procedure were used for statistical analysis. RESULTS. During the strongest nociceptive stimuli (airway access and abdominal catheter placement), the heart rate and systolic blood pressure increased significantly (p<0.001) in the control group compared to the dexmedetomidine group. Compared to baseline levels, the hemodynamic responses to nociceptive stimuli were more stable when dexmedetomidine was used in combination with inhaled isoflurane anesthesia. The need for supplemental doses of fentanyl and the hemodynamic parameters were similar for both groups. CONCLUSION. Dexmedetomidine combined with inhaled isoflurane for anesthesia of children submitted to videolaparoscopic appendectomy, efficiently blocks the hemodynamic responses to nociceptive stimuli. When compared to placebo, the use of dexmedetomidine did not change the need for supplemental doses of fentanyl for maintenance of hemodynamic parameters during the intraoperative period.

Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. DESCRITORES: educação médica; simulação; anestesia geral; anestesia local; bloqueio anestésico. ABSTRACTAIMS: To report the experience with teaching of anesthesiology to medical students in a practical and interactive way, using simulators in clinical scenarios of anesthesia with predetermined tasks. EXPERIENCE REPORT: In the Medical School of the Pontifical Catholic University of Rio Grande do Sul simulated clinical settings are used in general anesthesia and anesthetic blockage teaching. Complete equipment and drugs specific to each simulation are available. Students have direct performance in the simulator to perform in the presented situations. For each conduct, choice of drugs and doses required, filming is performed with the purpose of fixing and improving knowledge. CONCLUSIONS: Medical teaching of anesthesiology with simulators tends to be increasingly used, since it inserts the student in simulated situations close to the reality of the anesthetic process, in an interactive and attractive way without the real risk. Clinical situations of anesthesia or complications can be repeated until the fixation of knowledge and skills, before facing a situation with real patients.