• JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
 
  Bookmark and Share
 
 
Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2021.tde-23092021-123102
Document
Author
Full name
Sebastião Ernesto da Silva Filho
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Vieira, Joaquim Edson (President)
Bandeira, Celso Muller
Machado, Felipe Chiodini
Maximiano, Linda Ferreira
Title in Portuguese
Estratégia para cálculo da dose de sulfato de magnésio no paciente obeso: ensaio encoberto e com distribuição aleatória
Keywords in Portuguese
Analgesia
Analgésicos opioides
Bloqueio neuromuscular
Dor pós-operatória
Obesidade
Sulfato de magnésio
Abstract in Portuguese
Introdução e Objetivos: sulfato de magnésio mostrou ação analgésica e com grande vantagem na redução da dor pós-operatória e do consumo de analgésicos. Embora os pacientes obesos tenham recebido sulfato de magnésio e aproveitado seus efeitos benéficos, existe uma lacuna no conhecimento de sua farmacologia nessa população. Não há evidência para se apontar como superior o cálculo da dose desse fármaco usando o peso real, o peso ideal ou ideal corrigido desses pacientes. Este ensaio comparou a analgesia pós-operatória, e eventual interferência na ação do bloqueador neuromuscular entre duas estratégias de cálculo desta dose e as concentrações sanguíneas de magnésio geradas, usando o peso ideal corrigido e o peso real dos pacientes obesos. Métodos: uma amostra de 75 pacientes obesos programados para colecistectomia por via laparoscópica foi distribuída aleatoriamente em três grupos. No grupo controle os pacientes receberam apenas anestesia geral. No grupo peso real os pacientes receberam anestesia geral e sulfato de magnésio na dose de 40 mg.kg-1 de peso real. No grupo peso ideal corrigido os pacientes receberam anestesia geral e sulfato de magnésio na dose de 40 mg.kg-1 de peso ideal corrigido. Resultados: os pacientes dos grupos que receberam sulfato de magnésio apresentaram redução significativa no consumo de morfina (p 0,001) bem como na escala de dor no pós-operatório (p = 0,006) quando comparados com o grupo controle. Não houve diferença significativa entre os grupos que receberam sulfato de magnésio quanto ao consumo de morfina (p = 0,323) ou nos escores de dor (p = 0,082). Não houve diferença significativa entre os três grupos nos desfechos estudados relacionados com recuperação do bloqueio neuromuscular induzido pelo cisatracúrio (duração total do efeito p = 0,181). Não houve diferença estatística entre os grupos nas concentrações sanguíneas médias de magnésio entre os pacientes que receberam doses diferentes desse fármaco. Conclusão: sulfato de magnésio reduziu dor e consumo de analgésico sem alterar o efeito do cisatracúrio em obesos submetidos à colecistectomia. Não há diferença no efeito analgésico ou na concentração sérica de magnésio em obesos que recebem 40 mg.kg-1 pelo peso real ou ideal corrigido
Title in English
Strategy to calculate magnesium sulfate dose in obese patients: a randomized blind trial
Keywords in English
Analgesia
Magnesium sulphate
Neuromuscular blockade
Obesity
Opioid analgesics
Postoperative pain
Abstract in English
Introduction and Objectives: magnesium sulfate has shown analgesic properties with essential advantages related to reducing pain and analgesic consumption in the postoperative period. Although obese patients have received magnesium sulfate and have taken many benefits from it, there is a knowledge gap regarding the pharmacology of this substance in this population. There is no evidence to support the use of real, ideal, or corrected ideal body weight in calculating the dose of this medication. This trial aimed to compare postoperative analgesia and the possibility of interfering with the action of the neuromuscular blocking agent, between two alternative doses, using the actual or corrected ideal body weight to calculate them. It also compared the resulting blood concentration of magnesium in each group. Methods: a sample of 75 obese patients scheduled to undergo laparoscopic cholecystectomy was randomly assigned to three groups. Patients in the control group underwent only general anesthesia. In the actual weight group patients were given general anesthesia plus magnesium sulfate 40 mg.kg-1 of actual weight. In the corrected ideal body weight group general anesthesia was associated with magnesium sulfate 40 mg.kg-1 of corrected ideal body weight. Results: the patients from the groups receiving magnesium sulfate showed a significant decrease in the morphine consumption (p 0.001) and in the pain scores (p = 0.006) during the postoperative period, when compared to the control group. There was no significant difference in the consumption of morphine (p = 0.323) or in the pain scores (p = 0.082) between the groups that received magnesium sulfate. In addition, there was no difference in the total duration of neuromuscular block induced by cisatracurium between the three groups (p = 0.181). The groups of patients who received magnesium sulfate had similar blood magnesium concentrations throughout the study, despite different doses in each group. Conclusions: magnesium sulfate has decreased postoperative pain and morphine consumption without affecting cisatracurium recovery time in obese patients undergoing laparoscopic cholecystectomy. There was no difference in analgesia or blood magnesium concentrations among obese patients who received magnesium sulfate 40 mg.kg-1 using actual body weight compared to corrected ideal body weight
 
WARNING - Viewing this document is conditioned on your acceptance of the following terms of use:
This document is only for private use for research and teaching activities. Reproduction for commercial use is forbidden. This rights cover the whole data about this document as well as its contents. Any uses or copies of this document in whole or in part must include the author's name.
Publishing Date
2021-09-23
 
WARNING: Learn what derived works are clicking here.
All rights of the thesis/dissertation are from the authors
CeTI-SC/STI
Digital Library of Theses and Dissertations of USP. Copyright © 2001-2021. All rights reserved.