Monitoramento da pressão intracraniana para endoscopia digestiva alta: efeitos do Propofol e do Midazolam

Abstract

Upper digestive endoscopy is an indispensable examination in medical practice, allowing the diagnosis and monitoring of various pathologies of the gastrointestinal tract, this examination is fast and safe, but it can cause a degree of discomfort for the patient, and for the convenience of this and the endoscopist, the use of moderate sedation is frequent. Several drugs can be used to achieve this level of sedation, with propofol and midazolam being a frequent choice. Both drugs act on the central nervous system, however, their action on intracranial pressure hasn't been much explored, especially due to the invasive character of monitoring considered as the gold standard in medical practice. However, techniques for non-invasive monitoring of intracranial pressure already exist, such as the one used in this work and developed by the company Brain4care®. This technique consists of the use of a strain gauge sensor, which in contact with the scalp can detect the waves of intracranial pressure that generate small bone deformations. This system generates reports informing the P2/P1 ratio, and time to peak (TTP), parameters associated with the condition of intracranial pressure. Thus, the objective of this research was to assess intracranial pressure during upper digestive endoscopy and to compare the use of propofol and midazolam in relation to this parameter. For this, the research subjects were divided into two groups according to medical criteria: propofol and midazolam. Both groups had their blood pressure measured before and after the endoscopy, monitoring of intracranial pressure occurred during and after the exam. The data obtained were analyzed using SPSS software version 21®, and the graphs generated from Graphpad Prism 7.0®. There was no significant difference between age and gender between groups. In the comparison between the use of propofol and midazolam in relation to the P2/P1 ratio, TTP, systolic and diastolic pressure, there was no significant difference. In the comparison between the same group, in relation to the different moments of measurement and monitoring, there was a significant difference for the propofol group in the four parameters analyzed, and for midazolam only in relation to systolic pressure. The percentage distribution between individuals was performed (independent group), with changes in blood pressure and intracranial pressure, in relation to the two moments of approach. Systolic pressure was significantly higher before the exam, the comparison of the P2/P1 ratio was not significant. The clinical diagnosis and the region of the findings on the examination were associated with blood pressure and intracranial pressure, but there were no significant results. It is concluded that there are no significant differences between the two groups, but propofol causes significant changes in the P2/P1 ratio, in TTP, systolic and diastolic pressure after endoscopy, while midazolam significantly changes only the systolic pressure after endoscopy digestive system.