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2007, Número 2

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Rev Mex Anest 2007; 30 (2)


Despertar transoperatorio y análisis biespectral. Su impacto en la práctica de la anestesiología

Carrillo-Esper R, Carrillo-Córdova LD, Carrillo-Córdova JR

Idioma: Español
Referencias bibliográficas: 43
Paginas: 97-104
Archivo PDF: 82.67 Kb.


RESUMEN

El recuerdo de los eventos transoperatorios es uno de los principales temores de los enfermos que son sometidos a anestesia general. Sin embargo, el despertar y recuerdo transoperatorio se presenta en 1/1,000 pacientes en cirugía no cardiaca y en 3/1,000 en cirugía. Por lo anterior, el despertar transoperatorio es una de las complicaciones más serias de la anestesia, lo que se refleja en el gran número de artículos médicos y casos médico-legales. Los pacientes que presentan esta complicación refieren la sensación de parálisis, oyen conversaciones del quirófano y sienten la manipulación quirúrgica, lo que se asocia a gran angustia, miedo y dolor. Aunque la mayoría de los enfermos reconocen el evento como real, pocos lo refieren al anestesiólogo, el cual rara vez lo investiga. El síndrome de estrés postraumático es la secuela más frecuente, la cual impacta en la calidad de vida del enfermo. Los signos clínicos de respuesta autonómica y somática son los más usados para valorar la profundidad anestésica, pero tienen baja sensibilidad y especificidad como predictores de despertar transoperatorio. Otras modalidades para este fin (Técnica de antebrazo aislado, electromiograma frontal, contractilidad del esfínter esofágico inferior), no han demostrado su utilidad en la práctica clínica. Se han desarrollado alternativas para producir una versión simplificada del electroencefalograma (EEG) que prediga profundidad anestésica. En los últimos años se ha introducido a la práctica clínica un sistema de reconocimiento de patrones que integra varias determinantes del EEG. El análisis Biespectral ( BIS) (Aspect Medical Systems Inc, MA, USA), despliega una variable numérica que se deriva del análisis biespectral del EEG. El rango del BIS es de 0 a 100, valores por debajo de 60 están asociados con inconciencia. Ha mostrado en varios estudios clínicos que es un monitor adecuado de profundidad anestésica. Su uso en la práctica anestesiológica, para guiar la profundidad de la anestesia general, disminuye de manera significativa los despertares y recuerdos transoperatorios, optimiza la dosis de los medicamentos, reduce los tiempos de estancia en la unidad de cuidados postanestésicos y los costos.


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