Tremores intra e pós-operatório: prevenção e tratamento farmacológico

Abstract

RESUMOAlbergaria VF, Lorentz MN, Lima FAS -Tremores Intra e Pós-Operatório: Prevenção e Tratamento Farmacológico. JUSTIFICATIVA E OBJETIVOS:Os tremores podem ocorrer como um efeito adverso da intervenção cirúrgica e anestesia. A incidência de tremores pós-operatórios varia entre 6,3% e 66%. Pacientes jovens, sexo masculino, uso de agentes anestésicos halogenados e tempo prolongado de anestesia ou procedimento cirúrgico estão relacionados com tremores. Os tremores são involuntários e apresentam-se como atividade muscular oscilatória com finalidade de aumentar a produção de calor. Tremor pós-operatório é uma desagradável complicação que está relacionada com o aumento de morbidade. O tremor aumenta o metabolismo, resultando em um acréscimo de 200% a 500% no consumo de oxigênio. CONTEÚDO:Discute as causas, a prevenção e o tratamento dos tremores intra-e pós-operatório em pacientes adultos e pediátri-cos submetidos à intervenção cirúrgica sob anestesia geral ou do neuroeixo. CONCLUSÕES:Os tremores são, juntamente com náuseas e vô-mitos, causas de intenso desconforto na sala de recuperação pós-anestésica, além de potencialmente prejudiciais por gerarem aumento da demanda metabólica. Embora a presença de tremores não tenha sido diretamente relacionada com a morbidade cardía-ca, a prevenção tem se tornado tema de debate e de vários artigos científicos. A prevenção e o tratamento de tremores devem ser implementados. Pacientes com reserva cardiopulmorar limitada podem sofrer com acidose láctica, dessaturação venosa mista e hipoxemia.Unitermos: ANESTESIA: Geral, Locorregional; COMPLICAÇÕES: hipotermia, tremor; TREMOR: prevenção, tratamento. SUMMARYAlbergaria VF, Lorentz MN, Lima FAS -Intra-and Postoperative Tremors: Prevention and Pharmacological Treatment. BACKGROUND AND OBJECTIVES:Tremors can be an adverse effect of the surgical intervention and anesthesia. The incidence of postoperative tremors varies from 6.3% to 66%. Young age, male gender, the use of halogenated anesthetics, and prolonged anesthesia or surgical procedure are related with tremors. Tremors are involuntary and present as oscillating muscular activity aiming at increasing heat production. Postoperative tremors are a disagreeable complication related with increased morbidity. Tremors increase the metabolism, resulting in a 200% to 500% increase in oxygen consumption. CONTENTS:The objective of this paper was to discuss the causes, prevention, and treatment of intra-and postoperative tremors in adults and children undergoing general anesthesia or neuroaxis anesthesia for surgical interventions. CONCLUSIONS:Tremors, along with nausea and vomiting, cause severe discomfort in the recovery room, besides being highly prejudicial because they generate an increase in the metabolism. Although the presence of tremors has not been directly related with cardiac morbidity, its prevention has become the subject of discussion and several scientific reports. Prevention and treatment of tremors should be implemented. Patients with limited cardiovascular reserve could devel...

Diagnósticos de enfermería de complicaciones en la sala de recuperación anestésica

“…Durante la recuperación de la anestesia la inhibición desaparece y los temblores comienzan cuando la temperatura está por debajo del umbral de la regulación térmica. (9,10) Mendoza, Peniche (11) relatan que la caída de temperatura es inherente al proceso quirúrgico de los pacientes de la tercera edad debido a la alteración del sistema termorregulador por causa de drogas o de la anestesia. Asimismo, factores como la posición, temperatura de la sala de operaciones, calentamiento de los fluidos y uso de mantas también influyen en la temperatura corporal.…”

Hipotermia em pacientes no período perioperatório

“…The American Society of Anesthesiologists (ASA) developed a classification for the physical conditions of patients submitted to the anesthetic-surgical procedure, aimed at offering uniform general lines in the assessment of the seriousness of systemic diseases, physiological dysfunctions and anatomic abnormalities (3)(4) .…”

“…There is also deviation of hemoglobin dissociation curve to the left, contributing to a poorer oxygenation of the tissue; a reduction of the peripheral perfusion and decrease of the biotransformation of drugs, which may increase the duration of the action of neuromuscular blockers, sedatives, hypnotics and halogenated anesthetics, thus increasing the time of anesthetic recovery and prolonging unconsciousness; increase of the incidence of shivering, which may cause a large increase in the consumption of oxygen (400% to 500%), in the production of carbon dioxide and the cardiac and respiratory demands; greater blood viscosity and the occurrence of moderate coagulopathy, due to the visceral sequestration of platelets, decrease of the platelet function and reduction in the activity of the coagulation factors and decrease of factors related to the immunity, which increases infections and the length of stay (3)(4)8) .…”

“…The prevention of heat loss begins in the surgery room, since the patient under general anesthesia does not produce heat and depends on the environmental temperature (3)(4)(5) . The prevention measures must include increasing the environmental temperature in the surgery room.…”

“…Active rewarming involves methods immediately available at the surgery room, including the administration of warmed intravenous fluids and the use of heat radiation lamps and thermal blankets, especially those that spread hot air over the body surface. The rewarming of the airways if less effective because the content of heat in the gases is minimum (3)(4)(5)7,(10)(11) .…”