RESUMO
BACKGROUND: Transient cognitive dysfunction after general anesthesia is a frequent finding among elderly patients. The aim of this study was to evaluate whether the use of physostigmine may enhance recovery from general anesthesia in elderly patients. METHODS: Eighty American Society of Anesthesiologists (ASA) physical status I-III patients aged >65 years old who were scheduled for a laparoscopic cholecystectomy received either 2 mg physostigmine in 250 mL N/S 0.9% (Physo group) or 250 mL N/S 0.9% placebo (Control group) after induction of anesthesia via slow IV infusion over 45 minutes. This experiment was performed as a prospective, randomized, double-blinded study. Patients were assessed for sedation, orientation, ability to sit, and ability to pass the "picking up matches" test at 15 minutes, 8 hours, and 24 hours postoperatively. Patients were also evaluated for pain using the visual analogue scale (VAS) score both at rest and with movement. RESULTS: The time to extubation was significantly shorter in the Physo group than in the control group (8.0±2.7 vs. 9.8±3.6 min, P=0.012). The time required to pass the "picking up matches" test was also shorter for the Physo group at all of the time points postoperatively (15 minutes postoperatively: 18.0±7.1 vs. 24.6±11.6 sec, P=0.003, 8 hours postoperatively: 11.8±3.9 vs. 16.0±6.0 sec, P<0.001, 24 hours postoperatively: 8.8±3.4 vs. 11.2±4.7 sec, P=0.008). Evaluations of patient orientation and sedation were similar between the experimental and control groups. The VAS score and analgesic requirement were decreased in the Physo group compared to the control group during the first postoperative day. The ability to sit after extubation was also increased in the Physo group at both 15 minutes (P=0.001) and 8 hours postoperatively (P<0.001). CONCLUSION: The intraoperative infusion of physostigmine enhances alertness, coordination, manual dexterity and mobilization after general anesthesia in elderly patients, but physostigmine administration does not affect orientation or sedation.
Assuntos
Anestesia Geral , Inibidores da Colinesterase/uso terapêutico , Fisostigmina/uso terapêutico , Período Pós-Operatório , Idoso , Período de Recuperação da Anestesia , Atenção/efeitos dos fármacos , Pressão Sanguínea/efeitos dos fármacos , Colecistectomia Laparoscópica , Monitores de Consciência , Método Duplo-Cego , Feminino , Frequência Cardíaca/efeitos dos fármacos , Humanos , Masculino , Medição da Dor , Desempenho Psicomotor/efeitos dos fármacosRESUMO
Foi realizado estudo clinico em 15 pacientes com o objetivo de avaliar a evolucao a curto prazo da escoliose em adolescentes e adultos jovens, por meio de mensuracao da gibosidade com o angulo de Cobb, com a rotacao vertebral e com a escala visual analogica que quantifica a dor (EVA) e a correlacao dessas medidas radiograficas com a EVA. Os individuos de ambos os sexosforam submetidos a exame clinico por meio de uma ficha de avaliacao que constou da medida gibosidade com um nivel d`agua e uma regua. Nessa mensuracao, o sujeito realizou flexao anterior de tronco e o nivel d`agua foi colocado no ponto mais da gibosidade. A avaliacao da dor foi realizada pela EVA no exame radiologico foi determinada a medida do angulo de Cobb e amedida da rotacao vertebral por meio da regua de Raimondi...