Services on Demand
Revista Brasileira de Anestesiologia
On-line version ISSN 1806-907X
COSTA, Verônica Vieira da; SARAIVA, Renato Ângelo and DUARTE, Leonardo Teixeira Domingues. Regression of general anesthesia in patients with cerebral palsy: a comparative study using the bispectral index. Rev. Bras. Anestesiol. [online]. 2006, vol.56, n.5, pp. 431-442. ISSN 1806-907X. http://dx.doi.org/10.1590/S0034-70942006000500001.
BACKGROUND AND OBJECTIVES: It has been said that patients with cerebral palsy (CP) present a higher sensitivity to anesthetic agents, which may affect adversely the awakening from anesthesia. The objective of this study was to evaluate the recovery of patients with CP compared with patients without CNS disease. METHODS: The study population was composed of children ages 5 to 15, divided in two groups: those with a diagnosis of cerebral palsy and those without CNS disease. All of them underwent general anesthesia with sevoflurane associated with nitrous oxide and 50% oxygen. Besides the parameters commonly monitored, they also underwent EEG-BIS monitoring. Regression of general anesthesia during awakening from anesthesia, tracheal extubation, and the immediate postanesthetic period were evaluated according to the criteria adopted by Saraiva. The speed of elimination of the anesthetic agents was also evaluated, correlating it with the EEG-BIS values, and comparing the two groups of patients. Statistical analysis was done through exploratory analysis of the data and statistical testing comparing the means. The statistical difference was considered significant for values of p smaller or equal to 5%. RESULTS: Fifty-six patients were evaluated: 31 with CP and 25 without CNS disease. Both groups were homogenous regarding age and gender. Baseline EEG-BIS values for CP patients were smaller than those for the control group, and this difference was statistically significant (p = 0.04). During the first five minutes after discontinuation of sevoflurane, the elevation of the EEG-BIS values for CP patients was slower than for the control group. The speed of elimination of the anesthetic agent was similar in both groups. At 15 minutes, 48% of the patients in the control group were in stage II of anesthetic regression versus 29% of the patients with cerebral palsy. At 30 minutes, 72% of the patients in the control group were in condition to be discharged, in stage IV of anesthetic regression, versus 41.9% of the patients with CP. CONCLUSIONS: Patients with cerebral palsy presented a slower return to the conscious state when compared with patients in the control group.
Keywords : ANESTHESIA, General [inhalational]; DISEASES, Neurological [cerebral palsy]; POSTANESTHETIC RECOVERY [anesthesia regression].