Estudo comparativo entre bupivacaína a 0,25% e ropivacaína a 0,2% em anestesia peridural para cirurgia torácica

Abstract

RESUMO U N I T E R M O S -A N E S T É S I C O S , L o c a l : b u p i v a c a í n a

Anestesia no paciente com síndrome do pulmão encolhido: relato de caso

“…The decision on the choice of anesthesia is influenced by the surgical time and field, in addition to the patient's clinical conditions. The effects of epidural anesthesia on pulmonary function seem to be beneficial 8,9 . Both local anesthetics and opioids help diaphragmatic function, improving lung volume and capacity and reducing postoperative complications 9,10 .…”

“…Ropivacaine is a local anesthetic belonging to the pipecoloxylidide group, noted by the lower intensity of motor block and reduced potential for cardiovascular toxicity compared to bupivacaine 8,9 . It is known that the thoracic epidural block with concentrated solutions of bupivacaine causes a moderate reduction in vital capacity and in maximal inspiratory flow, probably due to a certain degree of relaxation of the intercostal muscles 8,9 . The use of less concentrated solutions of a local anesthetic such as ropivacaine may reduce the possibility of significant impairment of respiratory muscles 9 .…”

Peridural torácica alta associada ou não à peridural torácica baixa em pacientes ambulatoriais: implicações clínicas

“…Although the sensation of dispnea may 5, 21 or not 26,27 be a consequence of mild hypercapnia, respiratory distress referred by few patients may be a consequence of the excitation of "J" receptors of alveolar walls, as result of blood accumulation or vasodilation by thoracic sympathetic block, especially in dependent regions 28 , or by partial blockade of respiratory muscles motor fibers with decreased respiratory dynamics, phenomenon especially observed in anxious patients. Most of the times, hemoglobin desaturation depends on respiratory depression promoted by preanesthetic opioids or associated to epidural or spinal anesthetic solutions, changes in chest compliance 29 , tachypnea with low tidal air volume resulting in low effective alveolar ventilation and inhaled O 2 concentration. Since patients in our study have received oxygen via nasal catheter during the procedures, values obtained were stable or slightly higher that baseline values ( Figure 4).…”