Resumo
Objetivo: Realizar uma análise da literatura acerca dos aspectos pré-anestésicos e anestésicos das cirurgias, com enfoque nas cirurgias cardiovasculares. Revisão bibliográfica: As doenças cardiovasculares são a maior causa de morte no Brasil e no mundo e responsáveis por altos gastos em saúde pública no país, promovendo grande quantidade de cirurgias cardiovasculares. A avaliação do risco cirúrgico cardiovascular e o emprego correto dos anestésicos é fundamental para a redução das taxas de mortalidade por diminuir o risco de complicações. O Índice de Risco Cardíaco Revisado (Critério de Lee) é o principal critério utilizado atualmente, baseando-se nas comorbidades pré-existentes e no tipo de cirurgia. Todavia, para cirurgias cardiovasculares, os critérios precisam ser mais específicos, sendo utilizado o EuroSCOREII. Quanto ao emprego dos anestésicos, é necessário escolher aqueles que cumpram com o objetivo da cirurgia e possuam os efeitos adversos menos prejudiciais. Considerações finais: Cabe ao médico anestesiologista, já na consulta pré-operatória, avaliar o paciente e planejar todas as ações necessárias durante a cirurgia cardiovascular e o manejo da dor no pós-operatório. O papel do anestesiologista é essencial para possibilitar a estabilidade necessária ao trabalho do cirurgião cardiovascular, considerando os altos riscos do procedimento.
Referências
ALWARDT CM, et al. General anesthesia in cardiac surgery: a review of drugs and practices. The Journal of ExtraCorporeal Technology, 2005; 37(2): 227-35.
AMESS JAL, et al. Megaloblastic Hæmopoiesis In Patients Receiving Nitrous Oxide. The Lancet, 1978; 312(8085): 339-42.
BERWANGER O, et al. Association between pre-operative statin use and major cardiovascular complications among patients undergoing non-cardiac surgery: the VISION study. European Heart Journal, 2016; 37(2):177-85.
BONACCORSI HA, BURNS B. Perioperative Cardiac Management. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2020.
BOUNDS CG, NELSON VL. Benzodiazepines. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2020.
BRAUN LA, et al. Massage therapy for cardiac surgery patients – a randomized trial. The Journal of Thoracic and Cardiovascular Surgery, 2012; 144(6): 1453-9.
BUTTERWORTH JF, et al. Morgan and Mikhail’s clinical anesthesiology. 7th. ed. New York (NY): McGraw Hill, 2013.
BUYLAERT WA, et al. Cardiopulmonary Bypass and the Pharmacokinetics of Drugs: An Update. Clinical Pharmacokinetics, 1989; 17(1): 10-26.
CHAKRAVARTHY M. Modifying risks to improve outcome in cardiac surgery: An anesthesiologist’s perspective. Annals of Cardiac Anaesthesia, 2017; 20(2): 226-233.
CHENG MA, et al. Intravenous agents and intraoperative neuroprotection. Critical Care Clinics, 1997; 13(1): 185-99.
DEVEREAUX PJ, et al. Association Between Postoperative Troponin Levels and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. Journal of the American Medical Association, 2012; 307(21): 2295-2304.
FERRY N, DHANJAL S. Opioid Anesthesia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2020.
FOLINO TB, et al. Propofol. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2020.
FOT EV, et al. Automated Weaning from Mechanical Ventilation after Off-Pump Coronary Artery Bypass Grafting. Frontiers in Medicine, 2017; 21; 4: 31.
GERBERSHAGEN HJ, et al. Pain Intensity on the First Day after Surgery. Anesthesiology, 2013; 118(4): 934-44.
HERT SGD, et al. Sevoflurane but Not Propofol Preserves Myocardial Function in Coronary Surgery Patients. Anesthesiology, 2002; 97(1): 42-9.
KOHRS R, DURIEUX ME. Ketamine: Teaching an Old Drug New Tricks. Anesthesia & Analgesia, 1998; 87(5): 1186-93.
KRISTENSEN SD, et al. ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). European Heart Journal, 2014; 35(35): 2383-431.
LAYZER RB. Myeloneuropathy after Prolonged Exposure to Nitrous Oxide. The Lancet, 1978. 32(8102): 1227-30.
LEE TH, et al. Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery. Circulation, 1999; 100(10): 1043-9.
LONGNECKER DE, et al. Principles and practice of anesthesiology. 2nd ed. St. Louis: Mosby; 1998.
LOPEZ EO, et al. Cardiovascular Disease. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2020.
MONTEIRO GM, MOREIRA DM. Mortality in Cardiac Surgeries in a Tertiary Care Hospital of South Brazil. International Journal of Cardiovascular Sciences, 2015; 28(3): 200-205.
NASHEF SAM, et al. EuroSCORE II. European Journal of Cardio-Thoracic Surgery, 2012; 41(4): 734-44.
PATEL AY, et al. Cardiac Risk of Noncardiac Surgery. Journal of the American College of Cardiology, 2015; 66(19): 2140-2148.
PRINS C, et al. Cardiac surgery risk-stratification models. Cardiovascular Journal of Africa, 2012; 23(3): 160-164.
PUGSLEY MK. The diverse molecular mechanisms responsible for the actions of opioids on the cardiovascular system. Pharmacology & Therapeutics, 2002; 93(1): 51-75.
ROSENBAUM SB, et al. Ketamine. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2020.
ROSSEEL P, et al. Halothane treatment in life-threatening asthma. Intensive Care Medicine, 1985; 11(5): 241-6.
SINGH S, ZELTSER R. Cardiac Risk Stratification. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2020.
SIQUEIRA ASE, et al. Analysis of the Economic Impact of Cardiovascular Diseases in the Last Five Years in Brazil. Arquivos Brasileiros de Cardiologia, 2017; 109(1): 39-46.
SKIBISKI J, ABDIJADID S. Barbiturates. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2020.
SPRUNG J, et al. The Effects of Etomidate on the Contractility of Failing and Nonfailing Human Heart Muscle. Anesthesia & Analgesia, 2000; 91(1): 68-75.
TAN PS. The anaesthetic management of circulatory arrest. The British Journal of Hospital Medicine, 1990; 43(1): 36-41, 43-4.
TANAKA K, et al. Mechanisms of Cardioprotection by Volatile Anesthetics. Anesthesiology, 2004; 100: 707–721.
VAUGHN F, et al. Does Preoperative Anxiety Level Predict Postoperative Pain? AORN Journal, Mar 2007; 85(3): 589-604.
WARLTIER DC, et al. A Systematic Review of the Safety and Effectiveness of Fast-track Cardiac Anesthesia. Anesthesiology, 2003; 99: 982–987.
WHITE PF. Multimodal analgesia: its role in preventing postoperative pain. Curr Opin Investig Drugs, 2008; 9(1): 76-82.
WILLIAMS LM, et al. Etomidate. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2020.
ZUBRZYCKI M, et al. Assessment and pathophysiology of pain in cardiac surgery. Journal of Pain Research, 2018; 11: 1599–1611.
