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ANESTESIA GERAL

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Prof. Dr. Alberto Esteves Gemal ANESTESIA GERAL Conceitos Cirúrgicos Antigos On amputating a leg: "Cut quick with a crooked knife before covering the stump with the…

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Prof. Dr. Alberto Esteves Gemal ANESTESIA GERAL Conceitos Cirúrgicos Antigos On amputating a leg: "Cut quick with a crooked knife before covering the stump with the remaining skin," French medical author Joseph Charriere recommended. On treating wounds: "If the wound be only in the flesh you may bathe it with brandy and cover the part with a compressed dip in a warm wine quickened with spir vini," Charriere wrote. "If the wound is to the nervous parts you can dissolve sugar candy, camphire and myrrh in it." (Charriere was kind of onto something: A study in 2007 found wine kills germs in the mouth and throat.) On the best time for surgery: "Either Spring or Autumn," Charriere advised. "In the Spring, the blood is revived with greater heat whilst in the Autumn blood is calm." Treatise of the Operations of Surgery, 1712 Afinal, o que é Anestesia Geral? "A alma pode ser levada ao sono por medicamentos e, assim, superar a dor e produzir na mente um esquecimento em seu poder de percepção, semelhante à morte." Saint Hilaire de Poitiers 315-367 âQuando podemos expressar por medidas e números o assunto do qual estamos falando, sabemos algo sobre este assunto. Quando não podemos nos expressar em números, nosso conhecimento é ainda pequeno e insatisfatório, ainda arranhamos a superfície do conhecimento científico, qualquer que êle seja, apenas começando a avançar nesta ciência, qualquer que seja ela.â (Lord Kelvin) Por Quê Conceituar? O Processo de formação de um Raciocínio Estabelecer uma definição Seguir uma linha de conduta Tomar decisões com base neste raciocínio Comparar resultados Concluir Conceitos de Anestesia Geral Conceito Antigo Inconsciência x Dor é um flagelo dos Deuses Conceito Moderno Planos Anestésicos (1927 â Gueddel) Conceito Contemporâneo Inconsciência e Controle da Resposta ao Estímulo Nociceptivo (1987 â Prys-Roberts) Conceitos novos: Dor e Estimulo Nociceptivo Definições Bayleiâs (1751) Anestesia é um estado de inconsciência como em quem está atordoado Plomley (1847) Descreveu estágios de intoxicação, excitação e narcose Snow (1847) Relatou cinco graus de narcotismo Tempo medieval: cocções e esponjas soníferas Tempos modernos: inalações EVOLUÃÃO DOS CONCEITOS Guedel â Estágios e Planos de anestesia (1928) Rees & Gray â Três componentes da anestesia (BJA 22:83-89, 1950) Relaxamento Narcose Analgesia Woodbridge - Quatro componentes da anestesia (nothria ou torpor In: Anesthesiology 18:536-550, 1957) Sensorial Motor Mental Reflexógeno Planos Anestésicos de Gueddel Estágios de anestesia para o Ãter (1, 2, 3* e 4) em 1928 PROPOSTAS DO SÃCULO XXI P1- Anestesia Geral é um estado não natural em que a consciência é abolida e a capacidade do corpo reagir ao estímulo nociceptivo é controlada de maneira reversível por uma variedade de drogas. Prys-Roberts 1996 P2 - Dor é a percepção consciente e pessoal a um estímulo nocivo e/ou desagradável, ou interpretado como tal. IASP â Pain 6 (1979) 247-52 O que é Anestesia Geral? Um estado não natural em que: 1-A consciência do indivíduo é suprimida e 2-A habilidade de seu organismo em responder aos estímulos nociceptivos é controlada reversivelmente por ação de uma variedade de drogas, anestésicas ou não. Prys-Roberts, 1976 ...eventos de consciência pér operatória são tidos como aceitáveis apenas se considerados como risco justificável dado o fato de paciente tão seriamente doente de modo que a administração de anestésicos em concentração adequada possa resultar em injúria permanente ou mesmo morte. Se o paciente está anestesiado, logo inconsciente, não sente dor, mas pode apresentar respostas reflexas autonômicas, motoras, endócrino metabólicas, inflamatórias (e outras) ao estímulo nociceptivo (Domino KB & Aitkenhead, 2002) Anestésicos Gerais Hipnóticos receptor específico e inespecíficos Analgésicos Opióides, analgésicos anti-inflamatórios não esteróides, analgésicos âperiféricosâ Relaxantes Musculares Outras drogas de uso comum b-bloqueadores, a-2 agonistas, vasodilatadores, vasopressores, drogas cardio-ativas, antibióticos, anti-eméticos etc⦠Manuseio Intra Operatório Questão Básica O que é DOR? Individuo acordado Evocação de um sentimento interpretativo Evocação de um sentimento relacional O que são Respostas ao Estimulo Nociceptivo? (com o Indivíduo dormindo) Respostas intencionais e não intencionais Respostas motoras Resposta de sistemas fisiológicos DIFERENÃAS ENTRE DOR e ESTIMULO NOCICEPTIVO Paciente acordado E durante o sono anestésico⦠CAM50% CAM 95 CAM AWAKE CAM 99,95 CAM Bar Controle Pér Operatório Manuseio de sistemas fisiológicos no trans operatório P.ex.: Tensão arterial, frequencia de pulso, ventilação, manuseio das águas corporais incluindo reposição e controle de debito urinário, etc⦠CONVENIÃNCIA FARMACOLÃGICA Quando cessa o efeito do anestésico geral Cuidados no pós operatório imediato. Analgesia (aqui com o paciente consciente), estabilidade autonômica, hidratação, anti-eméticos, antibioticoterapia, cuidados ventilatórios, etc⦠Dimensões da Experiência Nociceptiva Sensorial-Discriminativa Nucleos no Talamo Ventroposterolateral Afetiva e Emocional Complexo Amigdaliano (estrutura límbica) Autonomica Hipotálamo Comportamental Tronco Cerebral: Núcleo Gigantocelular, Mesencefalo (PAG) e Núcleo Cuneiforme e Tálamo Medial Calvino & Grilo. Central Pain Control, 2006 Componentes da Experiência Dolorosa CONSCIÃNCIA é um Conceito Abstrato, logo Indefinível. Vigilia & Sono Memória Chart1 -3.0029 -1.0254 -1.4404 -8.0322 -13.0371 -12.0117 -12.4756 -17.2607 -17.5049 -11.1328 -9.6191 -9.9121 -7.5195 -3.125 3.9551 4.0283 2.0752 7.0313 9.9609 3.7109 -1.0986 -2.2705 3.3447 2.2461 -3.9551 -6.3965 -6.2012 -6.665 -11.377 -4.3457 1.8799 1.001 -3.9795 -4.126 1.5381 1.0254 2.0264 14.1846 20.5078 19.751 14.0625 9.668 7.959 4.3213 -1.9043 -7.666 -12.2559 -14.3311 -13.3057 -7.0557 -6.8359 -10.2539 -14.4775 -10.3027 -0.0488 4.1992 8.5205 11.6699 18.3105 15.1855 11.4502 9.5947 5.9326 4.5166 -4.6143 -7.0068 -9.79 -11.377 -4.8096 8.3252 5.3223 -2.5635 -6.5674 -2.5146 9.3262 11.3281 11.1328 10.3027 9.79 4.0771 1.3672 3.54 0.5127 -2.124 -5.6885 -5.835 -9.5703 -10.8154 -10.4492 -11.9385 -14.3555 -7.8613 -1.2451 2.3682 2.6123 2.0752 3.54 6.4453 9.4482 9.4727 11.2793 11.499 4.4189 5.0049 2.8076 -1.8555 -8.7646 -13.1592 -12.2314 -9.0088 -10.9131 -8.5938 -4.7363 1.0498 6.3721 4.5654 7.1045 14.1602 14.8682 8.4229 6.7871 4.6631 1.6357 -4.4189 -11.2793 -14.8682 -17.0898 -14.2822 -13.3789 -10.6201 -4.0771 -1.1475 -2.5146 -0.7813 7.4463 13.5742 15.8447 14.917 19.7998 19.8975 13.916 8.7891 3.7598 2.3926 -0.6836 -6.9336 -14.502 -18.3838 -20.7764 -15.0146 -13.3057 -13.9893 -10.9863 -7.251 -3.2715 -0.3418 1.6846 17.627 22.4121 12.4023 15.4785 23.6816 14.624 -2.8076 -15.4053 -13.4766 -10.1318 -12.7197 -16.1865 -16.2109 -11.4502 -5.7129 -2.6367 -0.708 7.1533 13.0615 16.6016 11.6943 10.5957 10.5225 14.8438 16.1377 7.9102 -1.6113 -5.6152 -4.8096 -3.5645 -6.4941 -12.915 -11.9629 -8.5693 -3.9795 -1.8555 2.2217 6.5674 8.3252 9.4482 14.9658 14.7705 7.6904 8.252 10.4248 3.0518 -3.3936 -10.7666 -13.9648 -11.2061 -5.2734 -11.8652 -12.3779 -9.668 -7.2754 -7.0068 -0.3662 12.4756 10.0586 1.3428 2.6123 5.1758 2.9541 9.8145 12.8418 10.0342 0.8789 -9.0088 -14.0381 -16.9678 -19.751 -23.7305 -19.751 -8.8867 -5.9082 -4.2969 -2.4902 6.4453 13.0127 12.4268 9.9854 12.915 10.376 13.0371 15.4541 7.7393 -0.1221 -5.4199 -10.791 -14.917 -13.7939 -13.2813 -9.3262 -5.3955 -7.2266 -8.6182 -6.4209 -0.7568 2.002 5.4932 11.5479 10.1807 4.3213 6.8848 14.5996 10.0098 2.2461 -2.5146 -4.2725 -8.3252 -9.7656 -9.2773 -7.7881 -11.0596 -11.1084 -7.0313 -2.9053 -1.7578 -3.9551 8.2764 24.6826 27.5879 19.5557 12.5977 11.4258 4.9316 -5.9814 -11.8652 -10.083 -13.8672 -14.4287 -9.9365 -7.1777 -6.1279 -15.1367 -17.1631 2.6123 19.6533 27.4414 26.4893 21.875 20.6299 14.7949 12.7197 10.0098 6.3477 3.9551 2.3438 -3.2715 -14.5264 -17.5049 -14.3799 -9.4727 -10.4004 -9.375 -7.1777 -5.6152 0.293 5.2246 4.0283 3.8574 6.3965 5.6152 5.5664 9.1064 4.6143 -4.1016 -11.7676 -13.3545 -10.0098 -11.5234 -17.2852 -13.2568 -9.2773 -9.082 -3.4668 2.0996 3.4912 3.125 6.665 9.3994 11.8652 9.3994 8.8867 11.5967 10.1807 5.2246 -2.0996 -8.0811 -10.6201 -12.2559 -13.916 -9.7412 -6.3477 -3.125 -1.6113 2.8564 6.5186 7.8125 9.2285 11.4502 14.6484 8.9355 5.4688 8.6426 8.2764 7.2998 3.4912 -2.71 -10.3271 -14.5508 -15.5273 -12.6709 -14.8193 -15.5273 -11.8652 -7.6416 -3.2471 2.8564 11.7432 17.2607 18.4814 13.9404 11.3525 11.0352 3.8818 -5.0049 -8.2764 -14.1846 -22.0947 -29.1016 -20.8252 -13.4766 -15.1855 -9.8877 -6.1768 3.125 15.0146 18.0176 15.7959 19.4824 26.709 21.1914 13.5498 9.9365 5.6885 1.6357 -4.5166 -9.3018 -10.9131 -11.5234 -13.9893 -5.6641 -0.8545 -3.418 -2.3926 2.9785 7.9346 9.6191 16.8213 17.5781 13.8672 6.7139 -1.4648 -1.2939 3.7598 7.373 -3.4668 -12.5 -16.3574 -18.6523 -19.6045 -9.1553 -5.4443 -6.7627 -6.25 -3.833 1.4648 5.542 8.9355 14.7461 16.1133 11.6943 9.0576 10.1807 7.3975 0.2441 -6.0303 -6.6162 -7.0068 -8.8135 -10.3516 -6.3721 -7.373 -9.7412 -6.7383 3.0762 8.3496 10.1807 11.0107 13.1836 14.6484 7.9834 0.7324 -1.416 2.7832 6.6406 -3.7354 -11.7676 -15.1123 -13.5498 -11.4014 -7.6172 -9.0332 -5.835 -1.2207 0.9521 2.8564 3.1006 4.3945 8.1055 15.8203 10.1563 5.0537 6.8359 0.2686 -6.4941 -0.1221 2.2949 -4.9561 -8.0566 -12.6709 -11.5479 -5.2979 -0.4395 -0.7813 0.6348 5.3467 4.834 3.3447 9.0332 16.7969 9.668 Sheet1 -3.0029 -1.0254 -1.4404 -8.0322 -13.0371 -12.0117 -12.4756 -17.2607 -17.5049 -11.1328 -9.6191 -9.9121 -7.5195 -3.125 3.9551 4.0283 2.0752 7.0313 9.9609 3.7109 -1.0986 -2.2705 3.3447 2.2461 -3.9551 -6.3965 -6.2012 -6.665 -11.377 -4.3457 1.8799 1.001 -3.9795 -4.126 1.5381 1.0254 2.0264 14.1846 20.5078 19.751 14.0625 9.668 7.959 4.3213 -1.9043 -7.666 -12.2559 -14.3311 -13.3057 -7.0557 -6.8359 -10.2539 -14.4775 -10.3027 -0.0488 4.1992 8.5205 11.6699 18.3105 15.1855 11.4502 9.5947 5.9326 4.5166 -4.6143 -7.0068 -9.79 -11.377 -4.8096 8.3252 5.3223 -2.5635 -6.5674 -2.5146 9.3262 11.3281 11.1328 10.3027 9.79 4.0771 1.3672 3.54 0.5127 -2.124 -5.6885 -5.835 -9.5703 -10.8154 -10.4492 -11.9385 -14.3555 -7.8613 -1.2451 2.3682 2.6123 2.0752 3.54 6.4453 9.4482 9.4727 11.2793 11.499 4.4189 5.0049 2.8076 -1.8555 -8.7646 -13.1592 -12.2314 -9.0088 -10.9131 -8.5938 -4.7363 1.0498 6.3721 4.5654 7.1045 14.1602 14.8682 8.4229 6.7871 4.6631 1.6357 -4.4189 -11.2793 -14.8682 -17.0898 -14.2822 -13.3789 -10.6201 -4.0771 -1.1475 -2.5146 -0.7813 7.4463 13.5742 15.8447 14.917 19.7998 19.8975 13.916 8.7891 3.7598 2.3926 -0.6836 -6.9336 -14.502 -18.3838 -20.7764 -15.0146 -13.3057 -13.9893 -10.9863 -7.251 -3.2715 -0.3418 1.6846 17.627 22.4121 12.4023 15.4785 23.6816 14.624 -2.8076 -15.4053 -13.4766 -10.1318 -12.7197 -16.1865 -16.2109 -11.4502 -5.7129 -2.6367 -0.708 7.1533 13.0615 16.6016 11.6943 10.5957 10.5225 14.8438 16.1377 7.9102 -1.6113 -5.6152 -4.8096 -3.5645 -6.4941 -12.915 -11.9629 -8.5693 -3.9795 -1.8555 2.2217 6.5674 8.3252 9.4482 14.9658 14.7705 7.6904 8.252 10.4248 3.0518 -3.3936 -10.7666 -13.9648 -11.2061 -5.2734 -11.8652 -12.3779 -9.668 -7.2754 -7.0068 -0.3662 12.4756 10.0586 1.3428 2.6123 5.1758 2.9541 9.8145 12.8418 10.0342 0.8789 -9.0088 -14.0381 -16.9678 -19.751 -23.7305 -19.751 -8.8867 -5.9082 -4.2969 -2.4902 6.4453 13.0127 12.4268 9.9854 12.915 10.376 13.0371 15.4541 7.7393 -0.1221 -5.4199 -10.791 -14.917 -13.7939 -13.2813 -9.3262 -5.3955 -7.2266 -8.6182 -6.4209 -0.7568 2.002 5.4932 11.5479 10.1807 4.3213 6.8848 14.5996 10.0098 2.2461 -2.5146 -4.2725 -8.3252 -9.7656 -9.2773 -7.7881 -11.0596 -11.1084 -7.0313 -2.9053 -1.7578 -3.9551 8.2764 24.6826 27.5879 19.5557 12.5977 11.4258 4.9316 -5.9814 -11.8652 -10.083 -13.8672 -14.4287 -9.9365 -7.1777 -6.1279 -15.1367 -17.1631 2.6123 19.6533 27.4414 26.4893 21.875 20.6299 14.7949 12.7197 10.0098 6.3477 3.9551 2.3438 -3.2715 -14.5264 -17.5049 -14.3799 -9.4727 -10.4004 -9.375 -7.1777 -5.6152 0.293 5.2246 4.0283 3.8574 6.3965 5.6152 5.5664 9.1064 4.6143 -4.1016 -11.7676 -13.3545 -10.0098 -11.5234 -17.2852 -13.2568 -9.2773 -9.082 -3.4668 2.0996 3.4912 3.125 6.665 9.3994 11.8652 9.3994 8.8867 11.5967 10.1807 5.2246 -2.0996 -8.0811 -10.6201 -12.2559 -13.916 -9.7412 -6.3477 -3.125 -1.6113 2.8564 6.5186 7.8125 9.2285 11.4502 14.6484 8.9355 5.4688 8.6426 8.2764 7.2998 3.4912 -2.71 -10.3271 -14.5508 -15.5273 -12.6709 -14.8193 -15.5273 -11.8652 -7.6416 -3.2471 2.8564 11.7432 17.2607 18.4814 13.9404 11.3525 11.0352 3.8818 -5.0049 -8.2764 -14.1846 -22.0947 -29.1016 -20.8252 -13.4766 -15.1855 -9.8877 -6.1768 3.125 15.0146 18.0176 15.7959 19.4824 26.709 21.1914 13.5498 9.9365 5.6885 1.6357 -4.5166 -9.3018 -10.9131 -11.5234 -13.9893 -5.6641 -0.8545 -3.418 -2.3926 2.9785 7.9346 9.6191 16.8213 17.5781 13.8672 6.7139 -1.4648 -1.2939 3.7598 7.373 -3.4668 -12.5 -16.3574 -18.6523 -19.6045 -9.1553 -5.4443 -6.7627 -6.25 -3.833 1.4648 5.542 8.9355 14.7461 16.1133 11.6943 9.0576 10.1807 7.3975 0.2441 -6.0303 -6.6162 -7.0068 -8.8135 -10.3516 -6.3721 -7.373 -9.7412 -6.7383 3.0762 8.3496 10.1807 11.0107 13.1836 14.6484 7.9834 0.7324 -1.416 2.7832 6.6406 -3.7354 -11.7676 -15.1123 -13.5498 -11.4014 -7.6172 -9.0332 -5.835 -1.2207 0.9521 2.8564 3.1006 4.3945 8.1055 15.8203 10.1563 5.0537 6.8359 0.2686 -6.4941 -0.1221 2.2949 -4.9561 -8.0566 -12.6709 -11.5479 -5.2979 -0.4395 -0.7813 0.6348 5.3467 4.834 3.3447 9.0332 16.7969 9.668 3.833 3.0762 0.0977 -3.54 -11.7676 -20.1172 -12.0117 -5.3467 -16.6504 -15.5273 -7.251 -4.0771 0.8301 8.4229 14.7461 11.2549 11.9629 15.3564 18.1152 14.917 8.7646 10.5957 6.1279 -0.0244 -5.4443 -9.082 -11.9629 -15.8691 -19.4824 -12.8174 -12.2559 -15.7471 -11.6455 2.8076 11.499 6.3721 3.8818 8.2275 14.7705 12.0361 3.6621 0.3906 -0.5127 3.6377 3.6865 -2.3438 -10.9863 -15.1611 -8.5938 -1.3428 -2.7344 -4.3701 -3.418 -0.415 2.8809 5.957 11.9873 16.1133 15.1855 6.4697 3.2959 6.0547 3.9307 3.418 6.8848 -0.0977 -10.3027 -13.8916 -15.5273 -11.6943 -12.085 -7.0557 0.3174 4.0283 6.8115 6.665 6.8604 12.4268 15.2832 10.5225 4.1992 4.9561 2.3926 -6.3477 -11.3037 -9.082 -11.5967 -8.3008 -12.6953 -14.2822 -13.8672 -9.4482 -7.1289 -2.7832 5.3223 9.0332 10.5225 7.7881 8.1543 4.834 -0.1465 9.375 20.3857 14.0625 0.2197 -2.9785 -4.8828 -8.4473 -15.8691 -13.8184 -1.7822 1.5625 -0.1953 0.8057 1.8799 4.834 12.9883 18.9453 19.5801 13.1104 7.2266 7.7637 4.9561 -1.1963 -7.8369 -9.9121 -13.1348 -15.4297 -16.9434 -13.2324 -15.2588 -15.4297 -10.5225 -5.3711 3.4912 12.0361 13.4033 14.0625 16.5771 9.3018 5.7373 6.4453 3.5889 -0.2441 -8.1787 -13.2568 -15.0146 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???? 255 0 0 0 2.0928 ???? 255 0 0 0 2.2236 ???? 255 0 0 0 2.3544 ???? 255 0 0 0 2.4852 ???? 255 0 0 0 2.616 ???? 255 0 0 0 2.7468 ???? 255 0 0 0 2.8776 ???? 255 0 0 0 3.0084 ???? 255 0 0 0 3.1392 ???? 255 0 0 0 3.27 ???? 255 0 0 0 3.4008 ???? 255 0 0 0 3.5316 ???? 255 0 0 0 3.6624 ???? 255 0 0 0 3.7932 ???? 255 0 0 0 3.924 ???? 255 0 0 0 4.0548 ???? 255 0 0 0 4.1856 ???? 255 0 0 0 4.3164 ???? 255 0 0 0 4.4472 ???? 255 0 0 0 4.578 ???? 255 0 0 0 4.7088 ???? 255 0 0 0 4.8396 ???? 255 0 0 0 4.9704 ???? 255 0 0 0 5.1012 ???? 255 0 0 0 5.232 ???? 255 0 0 0 5.3628 ???? 255 0 0 0 5.4936 ???? 255 0 0 0 5.6244 ???? 255 0 0 0 5.7552 ???? 255 0 0 0 5.886 ???? 255 0 0 0 6.0168 ???? 255 0 0 0 6.1476 ???? 255 0 0 0 6.2784 ???? 255 0 0 0 6.4092 ???? 255 0 0 0 6.54 ???? 255 0 0 0 6.6708 ???? 255 0 0 0 6.8016 ???? 255 0 0 0 6.9324 ???? 255 0 0 0 7.0632 ???? 255 0 0 0 7.194 ???? 255 0 0 0 7.3248 ???? 255 0 0 0 7.4556 ???? 255 0 0 0 7.5864 ???? 255 0 0 0 7.7172 ???? 255 0 0 0 7.848 ???? 255 0 0 0 7.9788 ???? 255 0 0 0 8.1096 ???? 255 0 0 0 8.2404 ???? 255 0 0 0 8.3712 ???? 255 0 0 0 8.502 ???? 255 0 0 0 8.6328 ???? 255 0 0 0 8.7636 ???? 255 0 0 0 8.8944 ???? 255 0 0 0 9.0252 ???? 255 0 0 0 9.156 ???? 255 0 0 0 9.2868 ???? 255 0 0 0 9.4176 ???? 255 0 0 0 9.5484 ???? 255 0 0 0 9.6792 ???? 255 0 0 0 9.81 ???? 255 0 0 0 9.9408 ???? 255 0 0 0 Sheet1 Sheet2 Sheet3 Tipos de Memória Mais Pertinentes à Anestesia Memória Explícita Declarativa (pesquisa direta porém tardia ou pós evento) Memória Implícita Não declarativa ou de procedimento (subconsciente e pesquisada por testes psicológicos) Anestesia Geral I-Vigília com Memória Explícita II-Vigília sem Memória Explícita porém com Memória Implícita III-Sono anestésico quimicamente induzidocom possível preservação de traços de Memória Implícita IV-Sono anestésico quimicamente induzido com depressão do sistema nervo central a tal ponto em que há baixa probabilidade de preservação de Memória Implícita Tipo I-Memória explícita de acontecimentos com dor Tipo II-Memória explícita de acontecimentos sem dor Tipo III-Ausência de memória explicita com possibilidade de sensibilização da memória implícita (SSPT) Qual a importancia de Anestesia Geral Adequada? Eventos Mnemônicos Pér Operatórios Farmacocinética da A.G. Transito da Droga no organismo Compartimentos Concentração no Sítio Efetor Alvo Biofase de interesse Qual a biofase? Farmacodinâmica da A.G. Dose x Efeito - Biofase e orgão alvo CAM Conceito e aplicação Concentração expirada de anestésicos inalatórios em que 50% dos indivíduos não apresentam resposta motora ao estímulo nociceptivo Multiplos da CAM50% - CAM95% - CAM99,5% - Ação primária (órgão alvo) & Efeitos Colaterais Anestesia Geral Anestésicos Inalatórios - CAM - Concentração (% vapor inspirado) Anestésicos Venosos MIR Taxa de infusão de anestésicos venosos capaz de inibir resposta motora em 50% dos indivíduos - Dose (mg.kg-1) CUIDADOS EM ANESTESIA GERAL Todo procedimento é passivel de ser feito por anestesia geral Todo procedimento pode complicar Cuidados gerais para todos procedimentos