AvaliaÃÃo dos nÃveis de pseudocolinesterase em portadores de esquistossomose mansÃnica na forma hepatoesplÃnica

AUTOR(ES)
DATA DE PUBLICAÇÃO

2004

RESUMO

Introduction: The hepatosplenic form of Schistosoma mansoni impairs a numbers of metabolic and liver activities that may interfere with the hepatic anesthetic drugs. The use of neuromuscular blockers in anesthesia are two objectives: 1) to provide relaxations of the muscles for endotracheal intubation; and 2) to preserve suitable conditions for the ventilation of the patient and the performance of the surgical team. Some neuromuscular blockers are metabolized by pseudocholinesterase, action a hepatic enzyme that is responsible for the metabolism of other drugs possessing an ester function. Purpose: To analyze plasmatic level of pseudocholinesterase in volunteers suffering from the hepatosplenic form of schistosomiasis. Method: Twenty-six patients with the hepatosplenic form of schistosomiasis were studied, divided into a group of 13 previously splenectomized individuals and a group of 13 who had not been submitted to surgery. Twelve healthy volunteers from the same regions and with the same socioeconomics status as the patients constituted the control group. All the healthy participants satisfied the exclusion criteria: no viral markers for hepatitis B and C, cirrhosis of the liver, associated diseases or use of drugs affecting the pseudocholinesterase. They had no history of bathing in the river or contact with contamined water and their Kato Katz test was negative. The following biochemical assays were performed: total proteins: albumin; prothrombine time; enzyme activity; international normal ration and pseudocholinesterase assay. Ultrasound was performed to assess the degree of periportal fibrosis. Results: The total protein and albumin fraction values likewise exhibited no statistically significant between the groups. The coagulation parameters showed a statistically significant difference between the splenectomized and nonsplenectomized groups (prothrombine time p=0.002); international normal ration p=0.004 and enzyme activity p=0.003). The pseudocholinesterase assay, there is a statistically significant between the nonsplenectomized and control groups (p=0.007). No such difference was observed, however, between the splenectomized and control groups. Conclusions: From the results it may be concluded that the pseudocholinesterase level is significantly lower in those suffering from the hepatosplenic form of Schistosoma mansoni who are not submitted to splenectomy. The splenectomy enhances the synthesis of pseudocholinesterase by the hepatocytes

ASSUNTO(S)

anestesia schistosoma mansoni pseudocolinesterase esquistossomose mansÃnica pseudocholinesterase anesthesia cirurgia

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