Reflexo de dilatação pupilar e a mensuração da dor no paciente anestesiado: revisão de literatura
DOI:
https://doi.org/10.34024/rnc.2021.v29.12438Palavras-chave:
sedoanalgesia, reflexo pupilar, pupilometriaResumo
Introdução. A validação da presença de dor em pacientes sob anestesia geral permanece um desafio. A correta mensuração da sedoanalgesia pode proporcionar o uso de doses mínimas para ser atingido, evitando-se subdosagens ou superdosagens. Estudos recentes têm correlacionado a pupilometria com o nível de dor no paciente não comunicativo. Objetivos. Por meio de uma revisão bibliográfica, procuramos correlacionar a pupilometria e o reflexo de dilatação pupilar na monitorização da analgesia, no paciente sedado e não comunicativo, sob o uso de opioides e hipnóticos, bem como comparar a pupilometria com o uso de parâmetros vitais como frequência cardíaca, uso do índice de analgesia e nocicepção e o BIS. Método. Foi realizada uma revisão bibliográfica na plataforma “PubMed”, em inglês, espanhol e português, entre o período de 1996 a 2020. A busca nas bases mencionadas resultou em 38 artigos. Resultados. Verificou-se que a pupilometria apresentou dados mais confiáveis na avaliação da nocicepção quando comparada com frequência cardíaca e pressão arterial, porém ainda há dificuldade de padronização de aplicação. A pupilometria mede diversos componentes: amplitude máxima, latência, velocidade de dilatação e contração, e tamanho máximo e mínimo. Quando avaliados os sinais vitais como frequência cardíaca e pressão arterial a pupilometria tem se mostrado um melhor preditor de analgesia, tornando-se um melhor indicador para a titulação, quando utilizados remifentanil ou propofol. Conclusões. A avaliação do reflexo de dilatação pupilar permite a mensuração da reatividade do sistema nervoso autônomo ao estímulo da dor, podendo proporcionar tratamento individualizado e com maior segurança.
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Copyright (c) 2021 Ana Beatriz Foleto Brait, Bruna Alvim Reis, Bruno Denardi Lemos, Isabela de Jesus Fernandes, Bruno Ambrósio da Rocha, Mirto Nelso Prandini
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Aceito: 2021-10-27
Publicado: 2021-12-17