Efecto de la Etilefrina en la velocidad de flujo sanguíneo cerebral para la hipotensión arterial causada por inducción anestésica intravenosa

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2022
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Universidad de Caldas
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Repositorio Institucional U. Caldas
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eng
spa
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oai:repositorio.ucaldas.edu.co:ucaldas/17454
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Palabra clave:
Presión sanguínea
Arterias
Circulación sanguínea
Etilefrine
Ultrasonography Doppler Transcranial
Transcranial color coded duplex ultrasonography
Middle cerebral artery mean blood velocity
Vasoconstrictors,
Cerebral blood flow
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dc.title.none.fl_str_mv Efecto de la Etilefrina en la velocidad de flujo sanguíneo cerebral para la hipotensión arterial causada por inducción anestésica intravenosa
title Efecto de la Etilefrina en la velocidad de flujo sanguíneo cerebral para la hipotensión arterial causada por inducción anestésica intravenosa
spellingShingle Efecto de la Etilefrina en la velocidad de flujo sanguíneo cerebral para la hipotensión arterial causada por inducción anestésica intravenosa
Presión sanguínea
Arterias
Circulación sanguínea
Etilefrine
Ultrasonography Doppler Transcranial
Transcranial color coded duplex ultrasonography
Middle cerebral artery mean blood velocity
Vasoconstrictors,
Cerebral blood flow
title_short Efecto de la Etilefrina en la velocidad de flujo sanguíneo cerebral para la hipotensión arterial causada por inducción anestésica intravenosa
title_full Efecto de la Etilefrina en la velocidad de flujo sanguíneo cerebral para la hipotensión arterial causada por inducción anestésica intravenosa
title_fullStr Efecto de la Etilefrina en la velocidad de flujo sanguíneo cerebral para la hipotensión arterial causada por inducción anestésica intravenosa
title_full_unstemmed Efecto de la Etilefrina en la velocidad de flujo sanguíneo cerebral para la hipotensión arterial causada por inducción anestésica intravenosa
title_sort Efecto de la Etilefrina en la velocidad de flujo sanguíneo cerebral para la hipotensión arterial causada por inducción anestésica intravenosa
dc.contributor.none.fl_str_mv Isaza Londoño, Carlos Felipe
dc.subject.none.fl_str_mv Presión sanguínea
Arterias
Circulación sanguínea
Etilefrine
Ultrasonography Doppler Transcranial
Transcranial color coded duplex ultrasonography
Middle cerebral artery mean blood velocity
Vasoconstrictors,
Cerebral blood flow
topic Presión sanguínea
Arterias
Circulación sanguínea
Etilefrine
Ultrasonography Doppler Transcranial
Transcranial color coded duplex ultrasonography
Middle cerebral artery mean blood velocity
Vasoconstrictors,
Cerebral blood flow
description Gráficas
publishDate 2022
dc.date.none.fl_str_mv 2022-02-24T00:06:16Z
2022-02-24T00:06:16Z
2022-02-24
dc.type.none.fl_str_mv Trabajo de grado - Especialización
http://purl.org/coar/resource_type/c_7a1f
Text
https://purl.org/redcol/resource_type/TP
dc.type.coarversion.fl_str_mv http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.identifier.none.fl_str_mv https://repositorio.ucaldas.edu.co/handle/ucaldas/17454
Universidad de Caldas
Repositorio institucional Universidad de Caldas
https://repositorio.ucaldas.edu.co/
url https://repositorio.ucaldas.edu.co/handle/ucaldas/17454
https://repositorio.ucaldas.edu.co/
identifier_str_mv Universidad de Caldas
Repositorio institucional Universidad de Caldas
dc.language.none.fl_str_mv eng
spa
language eng
spa
dc.relation.none.fl_str_mv 1. Hammermeister KE. Association between Intraoperative Hypotension and Hypertension and 30-day Postoperative Mortality in Noncardiac Surgery. Anesthesiology. 2015;123(2):307-319.
2. Lewis NCS, Smith KJ, Bain AR, Wildfong KW, Numan T, Ainslie PN. Impact of transient hypotension on regional cerebral blood flow in humans. Clin Sci. 2015;129(2):169-178. doi:10.1042/cs20140751
3. Südfeld S, Brechnitz S, Wagner JY, et al. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth. 2017;119(1):57-64. doi:10.1093/bja/aex127
4. Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005;100(1):4-10. doi:10.1213/01.ANE.0000147519.82841.5E
5. Chang HS, Hongo K, Nakagawa H. Adverse effects of limited hypotensive anesthesia on the outcome of patients with subarachnoid hemorrhage. J Neurosurg. 2000;92(6):971-975. doi:10.3171/jns.2000.92.6.0971
6. Reich DL, Bodian CA, Krol M, Kuroda M, Osinski T, Thys DM. Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery. Anesth Analg. 1999;89(4):814-822. doi:10.1097/00000539-199910000-00002
7. Sanborn K V., Castro J, Kuroda M, Thys DM. Detection of intraoperative incidents by electronic scanning of computerized anesthesia records: Comparison with voluntary reporting. Anesthesiology. 1996;85(5):977-987. doi:10.1097/00000542- 199611000-00004
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dc.publisher.none.fl_str_mv Facultad de Ciencias para la Salud
Manizales
Especialización en Anestesiología
publisher.none.fl_str_mv Facultad de Ciencias para la Salud
Manizales
Especialización en Anestesiología
institution Universidad de Caldas
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spelling Efecto de la Etilefrina en la velocidad de flujo sanguíneo cerebral para la hipotensión arterial causada por inducción anestésica intravenosaPresión sanguíneaArteriasCirculación sanguíneaEtilefrineUltrasonography Doppler TranscranialTranscranial color coded duplex ultrasonographyMiddle cerebral artery mean blood velocityVasoconstrictors,Cerebral blood flowGráficasspa: La Hipotensión intraoperatoria (HIO) posterior a la inducción anestésica está asociado a desenlaces adversos. Es de importancia tener un control de la presión arterial donde el uso de vasopresores es una medida eficaz para el tratamiento de HIO. Al realizar una corrección numérica de la presión arterial se debe considerar los efectos de los vasopresores en la hemodinámica cerebral. La literatura ofrece estudios de varios vasopresores disponibles, pero no de Etilefrina, ese es el propósito de esta investigación. Metodología: Se incluyeron pacientes adultos programados para cirugía electiva, que fueron tratados con Etilefrina (2mg) para la HIO causada por la inducción anestésica intravenosa con Remifentanil (TCI 6 ng/ml) + Propofol (2mg/kg). Se realizaron mediciones de velocidad de flujo sanguíneo cerebral en la arteria cerebral media (VmACM) por medio de ecografía dúplex transcraneal codificada por colores (Transcranial color coded duplex ultrasonography), velocidad media de arteria carótida interna (VmACI), presión arterial en 3 momentos diferentes: Basal, en HIO y posterior a aplicación de Etilefrina. Resultados: Se estudiaron 52 pacientes que presentaron HIO y fueron tratados con Etilefrina. Se presentó disminución significativa en los valores de PAM posterior a la inducción anestésica intravenosa (p< 0.00001), las VmACM promediadas en HIO posterior a la inducción anestésica disminuyeron respecto al valor basal (82.8 ±18.4 cm/s a 62.8 ±14.6 cm/s; p< 0.00001). Cuando fueron tratados con Etilefrina para la HIO, se observó un aumento significativo en la PAM (p< 0.00001), las VmACM también aumentaron de forma significativa (62.8 ±14.6 cm/s subió a 93.2 ±23.1 cm/s; p< 0.00001). Sin embargo los valores promediados de VmACM post-Etilefrina fueron muy superiores respecto a los valores basales (93.2 ±23.1 cm/s respecto al basal 82.8 ±18.4 cm/s; p< 0.00001). Para un análisis del efecto vasoconstrictor de Etilefrina en la circulación cerebral se calculó un indice de Lindegaard (IL), se comparó el valor de IL post-Etilefrina respecto al valor basal, el resultado fue normal en los 2 momentos (IL<3), pero con un descenso significativo (basal 1.79 ±0.5 y post-Etilefrina 1.2 ±0.3; p< 0.00001). Conclusión: La Etilefrina a la dosis usada en el presente estudio aumentó las velocidades de flujo sanguíneo cerebral en el manejo de la hipotensión intraoperatoria, incluso llevando a unos valores superiores respecto a los basales, con un indice de Lindegaard en rango normal pero menor respecto al basal, sugiriendo un efecto Hiperemico en la circulación cerebral.eng:Intraoperative hypotension (IOH) after anesthetic induction is associated with adverse outcomes. It is important to have blood pressure control where the use of vasopressors is an effective measure for the treatment of HIO. When performing a numerical correction of blood pressure, the effects of vasopressors on cerebral hemodynamics must be considered. The literature offers studies of several available vasopressors, but not Etilefrine, that is the purpose of this research. Methodology: Adult patients scheduled for elective surgery were included, who were treated with Etilefrine (2mg) for IOH caused by intravenous anesthetic induction with Remifentanil (TCI 6ng/ml) + Propofol (2mg/kg). Cerebral blood flow velocity measurements were made in the middle cerebral artery (MCAMV) by transcranial color coded duplex ultrasonography, internal carotid artery mean velocity (MCAMV), blood pressure at 3 different times : Basal, in HIO and after application of Etilefrine. Results: 52 patients who presented HIO and were treated with Etilefrine were studied. There was a significant decrease in MAP values ​​after intravenous anesthetic induction (p< 0.00001), the MVACM averaged in HIO after anesthetic induction decreased compared to the baseline value (82.8 ± 18.4 cm/s to 62.8 ± 14.6 cm/s; p<0.00001). When treated with Etilefrine for IOH, a significant increase in MAP was observed (p<0.00001), MVACM also increased significantly (62.8 ±14.6 cm/s rose to 93.2 ±23.1 cm/s; p<0.00001). . However, the average values ​​of VmMCA post-Etilefrine were much higher compared to baseline values ​​(93.2 ± 23.1 cm/s compared to baseline 82.8 ± 18.4 cm/s; p < 0.00001). For an analysis of the vasoconstrictor effect of Etilefrine in the cerebral circulation, a Lindegaard index (IL) was calculated, the value of post-Etilefrine IL was compared with the basal value, the result was normal at 2 moments (IL<3), but with a significant decrease (baseline 1.79 ±0.5 and post-Ethylephrine 1.2 ±0.3; p< 0.00001). Conclusion: Etilefrine at the dose used in the present study increased cerebral blood flow velocities in the management of intraoperative hypotension, even leading to higher values ​​compared to baseline, with a Lindegaard index in the normal range but lower compared to baseline. basal, suggesting a hyperemic effect on the cerebral circulation.1. Introducción / 2. Planteamiento del problema/ 3. Pregunta de investigación /4. Justificación / 5. Marco teórico / 5.1 Anatomía de circulación cerebral/ 5.2 Flujo sanguíneo cerebral/ 5.3 Presión de perfusión cerebral/ 5.4 Autorregulación del flujo sanguíneo cerebral/ 5.5 Teoría miogénica del FSC / 5.6 Teoría metabólica del FSC/ 5.7 Teoría neurológica del FSC / 5.8 Teoría química del FSC/ 5.9 Viscosidad del flujo sanguíneo cerebral/ 5.10 Temperatura / 5.11 Doppler transcraneal/ 5.12 Indice de Lindegaard / 5.13 Etilefrina / 6. OBJETIVOS / 6.1 Objetivo General /6.2 Objetivos específicos/ 7. METODOLOGÍA / 7.1 Tipo y nivel de investigación. / 7.2 Población de estudio/ 7.3 Criterios de inclusión para el estudio / 7.4 Criterios de exclusión para el estudio/ 7.5 Muestra. / 7.6 Técnica de recolección de datos/ 7.7 Protocolo de investigación/ 7.8 Plan de análisis estadístico/ 8. ASPECTOS ÉTICOS/ 9. RESULTADOS / 10. DISCUSIÓN / 11. Conclusión / 12. ANEXOS/ 12.1 Anexo 1: Instrumento de recolección de datos. / 12.2 Anexo 2: Matriz de variables del estudio / 12.3 Anexo 3: Consentimiento informado y comité de ética / 12.4 Anexo 4: Cronograma/ 12.5 Anexo 5: Presupuesto / 13. Referencias bibliográficas .EspecializaciónEspecialista en AnestesiologíaFacultad de Ciencias para la SaludManizalesEspecialización en AnestesiologíaIsaza Londoño, Carlos FelipeMORENO-REINA, RAMIRO2022-02-24T00:06:16Z2022-02-24T00:06:16Z2022-02-24Trabajo de grado - Especializaciónhttp://purl.org/coar/resource_type/c_7a1fTexthttps://purl.org/redcol/resource_type/TPhttp://purl.org/coar/version/c_970fb48d4fbd8a85application/pdfapplication/pdfapplication/pdfapplication/pdfhttps://repositorio.ucaldas.edu.co/handle/ucaldas/17454Universidad de CaldasRepositorio institucional Universidad de Caldashttps://repositorio.ucaldas.edu.co/engspa1. Hammermeister KE. Association between Intraoperative Hypotension and Hypertension and 30-day Postoperative Mortality in Noncardiac Surgery. Anesthesiology. 2015;123(2):307-319.2. Lewis NCS, Smith KJ, Bain AR, Wildfong KW, Numan T, Ainslie PN. Impact of transient hypotension on regional cerebral blood flow in humans. Clin Sci. 2015;129(2):169-178. doi:10.1042/cs201407513. Südfeld S, Brechnitz S, Wagner JY, et al. Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth. 2017;119(1):57-64. doi:10.1093/bja/aex1274. Monk TG, Saini V, Weldon BC, Sigl JC. Anesthetic management and one-year mortality after noncardiac surgery. Anesth Analg. 2005;100(1):4-10. doi:10.1213/01.ANE.0000147519.82841.5E5. Chang HS, Hongo K, Nakagawa H. Adverse effects of limited hypotensive anesthesia on the outcome of patients with subarachnoid hemorrhage. J Neurosurg. 2000;92(6):971-975. doi:10.3171/jns.2000.92.6.09716. Reich DL, Bodian CA, Krol M, Kuroda M, Osinski T, Thys DM. Intraoperative hemodynamic predictors of mortality, stroke, and myocardial infarction after coronary artery bypass surgery. Anesth Analg. 1999;89(4):814-822. doi:10.1097/00000539-199910000-000027. Sanborn K V., Castro J, Kuroda M, Thys DM. 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