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La morfina epidural disminuye la hipertensión postoperatoria al atenuar la hiperactividad del sistema nervioso
M J Breslow1, D A Jordan, R Christopherson
1Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Md 21205.
JAMA
|June 23, 1989
Resumen
El sulfato de morfina epidural redujo efectivamente la hipertensión postoperatoria después de la cirugía aórtica al reducir la actividad del sistema nervioso simpático. Esta intervención también disminuyó el dolor y la necesidad de analgésicos opioides adicionales.
Área de la Ciencia:
- Anestesiología Anestesiología.
- Cirugía cardiovascular La cirugía cardiovascular es una cirugía cardiovascular.
- Farmacología Farmacología.
Sus antecedentes:
- La hipertensión postoperatoria es una complicación común después de la cirugía aórtica abdominal.
- La hiperactividad del sistema nervioso simpático está implicada en su desarrollo.
- Se necesitan estrategias de gestión efectivas para mitigar este riesgo.
Objetivo del estudio:
- Evaluar el papel de la hiperactividad del sistema nervioso simpático en la hipertensión postoperatoria después de la cirugía aórtica abdominal.
- Evaluar la eficacia del sulfato de morfina epidural para atenuar esta respuesta.
Principales métodos:
- Un estudio aleatorizado, doble ciego, controlado con placebo que involucró a 24 pacientes adultos sometidos a cirugía aórtica abdominal.
- La administración de sulfato de morfina epidural (6 mg) frente a la solución salina y el placebo.
- El monitoreo de las puntuaciones de dolor, los niveles plasmáticos de norepinefrina, epinefrina y arginina vasopresina, y la presión arterial.
Principales resultados:
- Los pacientes que recibieron morfina epidural requirieron menos morfina parenteral e informaron puntuaciones de dolor más bajas.
- Se observaron niveles plasmáticos de norepinefrina notablemente más bajos en el grupo de morfina epidural.
- Menos pacientes en el grupo de morfina requirieron tratamiento para la hipertensión, con presiones sanguíneas generales más bajas después de la cirugía.
Conclusiones:
- La actividad del sistema nervioso simpático, no la epinefrina suprarrenal o la arginina vasopresina, impulsa la hipertensión después de la cirugía aórtica.
- Los narcóticos epidurales, específicamente el sulfato de morfina, son efectivos para atenuar esta respuesta simpática y reducir la hipertensión postoperatoria.
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