Estudio comparativo de cuatro técnicas de anestesia general en endarterectomía carotídea: respuesta inflamatoria, complicaciones cardiocirculatorias y analgesia postoperatoria

Resumen OBJETIVO: Estudiar el control hemodinamico analgesico y la respuesta inflamatoria, en pacientes sometidos a endarterectomia carotidea, bajo diferentes tipos de anestesia general. MATERIALES Y METODOS: Estudio prospectivo de 80 pacientes incluidos aleatoriamente en cuatro grupos: grupo 1, mantenimiento realizado con sevoflurano a CAM de 1; grupo 2, sevoflurano CAM de 1,5; grupo 3, remifentanilo; grupo 4, propofol. Se estudiaron las alteraciones hemodinamicas intra y postoperatorias, grado de analgesia postoperatoria, evolucion de las poblaciones leucocitarias y de los niveles de IL-6, variables clinicas del Sindrome de Respuesta Inflamatoria Sistemica en las primeras veinticuatro horas postoperatorias. RESULTADOS: Episodios de hipertension intraoperatorios: Grupo 1, 60%; Grupo 2, 65%; Grupo 3, 50%; Grupo 4, 60%. Episodios de hipotension intraoperatorios: Grupo 1, 85%; Grupo 2, 80%; Grupo 3, 80%; Grupo 4, 75%. Los pacientes de los grupos 3 y 4, presentaron mayor incidencia de Sindrome de Respuesta Inflamatoria Sistemica (p<0,05) en la primeras veinticuatro horas postoperatorias y niveles mas altos de IL-6 (p<0,05). La analgesia postperatoria no presento diferencias estadisticamente significativas entre grupos. CONCLUSION: Se encontro un aumento de los niveles de IL-6 perifericos, asi como un aumento de la incidencia de Sindrome de Respuesta Inflamatoria Sistemica en el postoperatorio inmediato de los grupos que no recibieron halogenados. Sin embargo el control hemodinamico y analgesico no presento diferencias significativas. Palabras clave: Endarterectomia carotidea. Anestesia balanceada. Remifentanilo. Anestesia intravenosa. Hipnoticos halogenados. Respuesta inflamatoria. Citocinas. Comparison of 4 techniques for general anesthesia for carotid endarterectomy: inflammatory response, cardiocirculatory complications, and postoperative analgesia Summary OBJETIVE: To study the analgesia, hemodynamic stability and inflammatory response in patients undergoing carotid endarterectomy under different types of general anesthesia. MATERIALS AND METHODS: A comparison of 80 patients randomized to 4 groups: group 1, maintenance with sevoflurane at a minimum alveolar concentration (MAC) of 1; group 2, sevoflurane at MAC 1.5; group 3, remifentanil; group 4, propofol. Variables studied were hemodynamic alterations during and after surgery, level of postoperative analgesia, differential white cell counts, levels of interleukin-6 (IL-6), and clinical signs and symptoms of systemic inflammatory response syndrome in the first 24 hours after surgery. RESULTS: The incidences of episodes of intraoperative hypertension were 60% in group 1, 65% in group 2, 50% in group 3, and 60% in group 4. The incidences of episodes of intraoperative hypotension were 85% in group 1, 80% in group 2, 80% in group 3, and 75% in group 4. Patients in groups 3 and 4 had higher incidences of systemic inflammatory response syndrome (p<0.05) in the first 24 hours after surgery and higher levels of IL-6 ( p<0.05). Postoperative analgesia was similar in all 4 groups. CONCLUSIONS: Increased levels of IL-6 in peripheral blood and of systemic inflammatory response syndrome were found in the early postoperative period in groups that did not receive halogenated gases. Hemodynamic stability and analgesia were similar in all groups, however.