Considerações de Anestesiologia em Cirurgias com Monitorização Neurofisiológica Intraoperatória
DOI:
https://doi.org/10.25751/rspa.48855Palavras-chave:
Monitorização Neurofisiológica Intraoperatória, Potenciais Evocados, Procedimentos Neurocirúrgicos, Anestesia Geral, AnestésicosResumo
A monitorização neurofisiológica intraoperatória permite avaliar em tempo real a função das estruturas nervosas durante a cirurgia e identificar alterações reversíveis antes que evoluam para lesão permanente. A sua interpretação depende do regime anestésico e das condições fisiológicas do doente. Esta revisão narrativa reúne a evidência sobre a influência dos agentes farmacológicos e das variáveis fisiológicas nas diferentes modalidades de monitorização. A pesquisa decorreu na PubMed até fevereiro de 2025 e foram retidos 43 estudos. Os agentes anestésicos deprimem os potenciais evocados em função do fármaco, da dose e do número de sinapses da via monitorizada. As respostas corticais e musculares são as mais suscetíveis. A anestesia total intravenosa com propofol e remifentanilo constitui a técnica mais favorável à preservação dos sinais, sobretudo na monitorização dos potenciais evocados motores. Pesam igualmente a estabilidade do plano anestésico e o controlo da pressão arterial, da ventilação, da temperatura e da hemoglobina. Perante uma alteração do sinal, a resposta deve ser estruturada e multidisciplinar, com comunicação entre as equipas de neurofisiologia, anestesia e cirurgia.
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Direitos de Autor (c) 2026 João Carlos Leote Rebocho, Marta Baptista, Maria Batista, António Hick-Perez, Ricardo Calhau
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