Influência da técnica anestésica na dor e qualidade da recuperação pós-operatória em colecistectomias laparoscópicas: estudo comparativo
Arquivos
Data
2023-08-24
Autores
Guimarães, Claudia Fernanda Silva 
Orientadores
Casali, Karina Rabello
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A colecistectomia consiste na remoção cirúrgica da vesícula biliar, e é amplamente realizada pelo mundo, por meio de laparotomia, também chamada de aberta, ou por laparoscopia, que é minimamente invasiva, possibilitando menor morbidade, tempo de internação hospitalar, recuperação pós-operatória e custos. Considerando que o manejo inadequado da dor pós-operatória afeta a recuperação do paciente, podendo implicar em aumento no tempo de internação ou até aumento do risco de eventos cardiovasculares após cirurgias não-cardíacas, a aplicação de técnicas não invasivas para estudo e melhora das estratégias de controle da dor tornam-se de suma importância clínica. Neste contexto, com o intuito de melhorar a avaliação da dor pós-operatória, no primeiro estudo (Artigo 1) utilizamos a escala analógica visual de dor e avaliação de parâmetros autonômicos, em colecistectomias abertas e laparoscópicas. Os resultados demonstraram maior nível de dor nos pacientes submetidos a cirurgia laparoscópica, o que pode ser atribuído à anestesia peridural (associada a anestesia geral), realizada apenas nos pacientes submetidos à cirurgia aberta. Como a resposta fisiológica autonômica ao estresse anestésico-cirúrgico é um evento importante nas cirurgias laparoscópicas, a avaliação dos efeitos autonômicos nas duas técnicas anestésicas, no mesmo procedimento, colecistectomias laparoscópicas, ainda não explorada na literatura, ajudaria no melhor entendimento sobre os possíveis mecanismos envolvidos na recuperação dos pacientes. Assim sendo, no segundo trabalho (Artigo 2), comparamos os efeitos da anestesia geral, associada ou não a anestesia peridural, em colecistectomias laparoscópicas. Os resultados mostraram que 6 horas após a cirurgia, a variabilidade da frequência cardíaca foi maior no grupo submetido à associação de anestesia geral e peridural, demonstrando um melhor perfil autonômico pós cirúrgico. Além disso, a avaliação 15 dias após a cirurgia, ao contrário do esperado, indicou que o efeito autonômico apresentado no grupo que recebeu anestesia peridural foi mantido, ou seja, os pacientes apresentavam ainda uma modulação parassimpática maior que seus valores pré cirúrgicos e, em adicional, maiores também quando comparados ao grupo que recebeu apenas anestesia geral. Por outro lado, o grupo que recebeu somente anestesia geral, também apresentou efeitos mantidos após 15 dias, com modulação simpática aumentada. Ou seja, a modulação autonômica no pós-operatório permanece por mais de 15 dias, mantendo seus efeitos benéficos ou maléficos, conforme o manejo anestésico dos pacientes. Portanto, tais resultados obtidos nessa dissertação nos levam à necessidade de novas investigações sobre a modulação autonômica no pós-operatório tardio e suas implicações, assim como também possíveis inovações tecnológicas que nos possibilitem melhor avaliação, com consequente melhor desfecho dos pacientes cirúrgicos em geral.
Cholecystectomy consists of the surgical removal of the gallbladder, and is widely performed around the world, through laparotomy, also called open, or laparoscopy, which is minimally invasive, allowing for less morbidity, length of hospital stay, postoperative recovery and costs. Considering that inadequate management of postoperative pain affects the patient's recovery, which may result in an increase in hospital stay or even an increase in the risk of cardiovascular events after non-cardiac surgeries, the application of non-invasive techniques to study and improve strategies of pain control become of paramount clinical importance. In this context, with the aim of improving the assessment of postoperative pain, in the first study (Article 1) we used the visual analogue pain scale and assessment of autonomic parameters, in open and laparoscopic cholecystectomies. The results demonstrated a higher level of pain in patients undergoing laparoscopic surgery, which can be attributed to epidural anesthesia (associated with general anesthesia), performed only in patients undergoing open surgery. As the autonomic physiological response to anesthetic-surgical stress is an important event in laparoscopic surgeries, the evaluation of the autonomic effects of the two anesthetic techniques, in the same procedure, laparoscopic cholecystectomies, not yet explored in the literature, would help to better understand the possible mechanisms involved. in the recovery of patients. Therefore, in the second study (Article 2), we compared the effects of general anesthesia, associated or not with epidural anesthesia, in laparoscopic cholecystectomies. The results showed that 6 hours after surgery, heart rate variability was greater in the group submitted to the combination of general and epidural anesthesia, demonstrating a better post-surgical autonomic profile. Furthermore, the evaluation 15 days after surgery, contrary to expectations, indicated that the autonomic effect presented in the group that received epidural anesthesia was maintained, that is, the patients still presented a parasympathetic modulation greater than their pre-surgical values and, in additional, also higher when compared to the group that received only general anesthesia. On the other hand, the group that received only general anesthesia also showed effects maintained after 15 days, with increased sympathetic modulation. In other words, post-operative autonomic modulation remains for more than 15 days, maintaining its beneficial or harmful effects, depending on the patients' anesthetic management. Therefore, such results obtained in this dissertation lead us to the need for new investigations into autonomic modulation in the late postoperative period and its implications, as well as possible technological innovations that allow us to better evaluate, with a consequent better outcome for surgical patients in general.
Cholecystectomy consists of the surgical removal of the gallbladder, and is widely performed around the world, through laparotomy, also called open, or laparoscopy, which is minimally invasive, allowing for less morbidity, length of hospital stay, postoperative recovery and costs. Considering that inadequate management of postoperative pain affects the patient's recovery, which may result in an increase in hospital stay or even an increase in the risk of cardiovascular events after non-cardiac surgeries, the application of non-invasive techniques to study and improve strategies of pain control become of paramount clinical importance. In this context, with the aim of improving the assessment of postoperative pain, in the first study (Article 1) we used the visual analogue pain scale and assessment of autonomic parameters, in open and laparoscopic cholecystectomies. The results demonstrated a higher level of pain in patients undergoing laparoscopic surgery, which can be attributed to epidural anesthesia (associated with general anesthesia), performed only in patients undergoing open surgery. As the autonomic physiological response to anesthetic-surgical stress is an important event in laparoscopic surgeries, the evaluation of the autonomic effects of the two anesthetic techniques, in the same procedure, laparoscopic cholecystectomies, not yet explored in the literature, would help to better understand the possible mechanisms involved. in the recovery of patients. Therefore, in the second study (Article 2), we compared the effects of general anesthesia, associated or not with epidural anesthesia, in laparoscopic cholecystectomies. The results showed that 6 hours after surgery, heart rate variability was greater in the group submitted to the combination of general and epidural anesthesia, demonstrating a better post-surgical autonomic profile. Furthermore, the evaluation 15 days after surgery, contrary to expectations, indicated that the autonomic effect presented in the group that received epidural anesthesia was maintained, that is, the patients still presented a parasympathetic modulation greater than their pre-surgical values and, in additional, also higher when compared to the group that received only general anesthesia. On the other hand, the group that received only general anesthesia also showed effects maintained after 15 days, with increased sympathetic modulation. In other words, post-operative autonomic modulation remains for more than 15 days, maintaining its beneficial or harmful effects, depending on the patients' anesthetic management. Therefore, such results obtained in this dissertation lead us to the need for new investigations into autonomic modulation in the late postoperative period and its implications, as well as possible technological innovations that allow us to better evaluate, with a consequent better outcome for surgical patients in general.
Descrição
Citação
GUIMARÃES, C. F. S. Influência da técnica anestésica na dor e qualidade da recuperação pós-operatória em colecistectomias laparoscópicas: estudo comparativo. 2023. 60 p. Dissertação (Mestrado em Engenharia Biomédica) - Instituto de Ciência e Tecnologia, Universidade Federal de São Paulo, São José dos Campos, 2023.