), após 5 minutos (M0) avaliou-se o grau de sedação de intensidade de dor, pressões arteriais sistólica e diastólica, freqüências cardíaca e respiratória e saturação de oxigênio. O eletrofisiologista avaliou as variáveis de condução cardíaca (duração do QRS, intervalos AA, AH, HV e PA), o tempo de recuperação do nódulo sinoatrial e as variáveis de refratariedade cardíaca (período refratário do átrio direito, período refratário do ventrículo direito e período refratário do nódulo atrioventricular). Após as medidas iniciais o remifentanil foi introduzido (bolus de 0,5 µg.kg -1 + infusão de 0,05 µg.kg ) e após 20 minutos as mesmas variáveis foram reavaliadas (M1). RESULTADOS: Observou-se diminuição das pressões sistólica e diastólica (p = 0,0001) entre M0 e M1, sem diferença estatística significativa da freqüência respiratória ou da saturação de oxigênio. Houve aumento do intervalo átrio-His (p = 0,006) e do tempo de recuperação do nódulo sinoatrial (p = 0,0004), do período refratário do átrio direito (p = 0,001) e do período refratário do nódulo atrioventricular (p = 0,0001), porém não houve diminuição da freqüência cardíaca basal entre M0 e M1. CONCLUSÕES: O remifentanil alterou as variáveis eletrofisiológi-cas cardíacas, o que em doses maiores que as estudadas poderiam causar bradicardia sinusal, assistolia e distúrbios de condução. Unitermos: ANALGÉSICOS, Opióide: remifentanil, CIRURGIA, Cardíaca: ablação; COMPLICAÇÕES: assistolia, bradicardia; FISIOLO-GIA, Cardiovascular: condução, refratariedade. SUMMARYLeite SS, Firme EBP, Bevilaqua MS, Pereira LS, Atié J -Prospective Study on the Repercussions of Low Doses of Remifentanil on Sinoatrial Function and in Cardiac Conduction and Refractory Period. BACKGROUND AND OBJECTIVES:Remifentanil is an opiod with fast onset of action and short acting, and its use in short-duration procedures has increased in the last few years. Bradycardia and asystole are among the side effects reported. The objective of this study was to evaluate the effects of this drug in cardiac conduction and refractory period in human beings. METHODS: A prospective study with 16 patients, ages 18 to 65, both genders, ASA I to III, undergoing elective intracardiac electrophysiological study, was undertaken. Patients with disorders of the sinoatrial node and those with severe cardiac blocks were excluded. In the laboratory of electrophysiology, patients were sedated with midazolam (0.03 mg.kg -1 ) after 5 minutes the degree of sedation and degree of pain, systolic and diastolic blood pressure, heart rate and respiratory rate, and oxygen saturation were evaluated. The electrophysiologist evaluated cardiac conduction (duration of the QRS complex, and AA, AH, HV, and PA intervals), duration of sinoatrial node recovery, and cardiac refractory period (refractory period of the right atrium, right ventricle, and atrioventricular node). After the initial measurements, remifentanil was administered (bolus of 0.5 µg.kg -1 + infusion of 0.05 µg.kg -1 .min -1 ) and, after 20 minutes, the same parameters were eval...

Inappropriate therapy of postoperative pain in laparoscopic cholecystectomy may lead to late mobilization, patient dissatisfaction, delayed hospital discharge, and chronic pain development. Our objective was to identify the best therapeutic strategy available to the anesthesiologist for the acute postoperative pain of patients submitted to elective laparoscopic cholecystectomy. This is a systematic review that included 36 complete articles indexed in the Medline, Scopus, Web of Science and LILACS databases, with a five-year time cut (2012 to 2016), resulting from controlled and randomized studies that were submitted to qualitative analysis. In a proposal for multimodal analgesia, it is important to consider the contraindications, adverse effects, dose and optimal timing of interventions. Non-opioid drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs)/cyclooxygenase-2 (COX-2) inhibitors, gabapentin/pregabalin, N-methyl-D-aspartate (NMDA) receptor antagonists, and others. Opioids may be used at low doses associated with multimodal therapy or are restricted to cases where non-opioid multimodal analgesia is insufficient. We conclude that there is no consensus as to the best analgesic strategy to be implemented in the acute postoperative pain of laparoscopic cholecystectomy, which requires its applicability in an individualized way, based on the scientific evidence found in the literature. As contribution to medical learning and practice, we point out the theoretical enrichment of the analgesic drug options available for the therapy of postoperative pain in patients submitted to elective laparoscopic cholecystectomy, and alert the team to consider the adverse effects of the interventions implemented.