RESUMEN
BACKGROUND: Midazolam is routinely used as preanesthetic medication in pediatric patients. Recently, dexmedetomidine has emerged as an alternative as a premedicant. We aimed to add more evidence about the efficacy and safety of two common routes of administration for pediatric premedication: oral midazolam versus intranasal dexmedetomidine. METHODS: We systematically searched Randomized Controlled Trials (RCTs) involving patients ≤ 18 years old undergoing preanesthetic medication and comparing intranasal dexmedetomidine with oral midazolam. Risk Ratio (RR) and Mean Difference (MD) with 95% Confidence Intervals (95% CI) were computed using a random effects model. Trial-sequential analyses were performed to assess inconsistency. RESULTS: Sixteen RCTs (1,239 patients) were included. Mean age was 5.5 years old, and most procedures were elective. There was no difference in satisfactory induction or mask acceptance (RR = 1.15, 95% CI 0.97-1.37; p = 0.11). There was a higher incidence of satisfactory separation from parents in the dexmedetomidine group (RR = 1.40; 95% CI 1.13-1.74; p = 0.002). Dexmedetomidine was also associated with a reduction in the incidence of emergence agitation (RR = 0.35; 95% CI 0.14-0.88; p = 0.02). Heart rate and mean arterial pressure were marginally lower in the dexmedetomidine group but without clinical repercussions. CONCLUSION: Compared with oral midazolam, intranasal dexmedetomidine demonstrated better separation from parents and lower incidence of emergence agitation in pediatric premedication, without a difference in satisfactory induction. Intranasal dexmedetomidine may be a safe and effective alternative to oral midazolam for premedication in pediatric patients.
Asunto(s)
Dexmedetomidina , Hipnóticos y Sedantes , Midazolam , Medicación Preanestésica , Niño , Preescolar , Humanos , Administración Intranasal , Administración Oral , Dexmedetomidina/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Midazolam/administración & dosificación , Medicación Preanestésica/métodos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Up to 60% of pediatric surgical patients develop high levels of preoperative anxiety. This study compared the effects of oral combinations of midazolam and ketamine with oral midazolam alone for pediatric preanesthetic medication. METHODS: The study protocol was registered in PROSPERO as CRD42020172920. A systematic literature search was conducted using Medline, Cochrane, EMBASE, CENTRAL, and Web of Science for randomized controlled trials comparing oral combinations of midazolam and ketamine with midazolam alone as preanesthetic medication in elective surgical pediatric patients. Meta-analyses included the following outcomes: anxiety and sedation levels, child...s behavior during separation from parents, face mask acceptance, and venipuncture. The quality of evidence was assessed using GRADE criteria. RESULTS: Twenty studies were included. The following effects (RR (95% CI)) were observed for combinations of ketamine and midazolam relative midazolam alone: anxiolysis (1.2 (0.94...1.52); p.ß=.ß0.15; I2.ß=.ß80%; GRADE.ß=.ßvery low); satisfactory sedation (1.2 ( 1.10...1.31); p.ß<.ß0.001; I2.ß=.ß71%; GRADE.ß=.ßvery low); behavior during parental separation (1.2 (1.06...1.36); p.ß=.ß0.003; I2.ß=.ß88%; GRADE.ß=.ßvery low); facial mask acceptance (1.13 (1.04...1.24); p.ß=.ß0.007; I2.ß=.ß49%; GRADE.ß=.ßvery low); behavior during venipuncture (1.32 (1.11...1.57); p.ß=.ß0.002; I2.ß=.ß66%; GRADE.ß=.ßvery low). CONCLUSIONS: While similar probabilities of obtaining anxiolysis were found, adequate sedation, calm behavior during child...s separation from parents, low levels of fear during face mask adaptation, and cooperative behavior during peripheral venous cannulation were more likely with midazolam-ketamine combinations.
Asunto(s)
Anestesia , Ketamina , Niño , Humanos , Midazolam , Medicación Preanestésica/métodos , Ansiedad , Hipnóticos y SedantesRESUMEN
Introducción: la ketamina se utiliza como premedicación anestésica.Objetivo: evaluar el efecto de la premedicación con ketamina intramuscular en el nivel de ansiedad del paciente pediátrico ante una cirugía de urgencia. Método: se realizó un estudio preexperimental con preprueba y posprueba en el Hospital Provincial de Ciego de Ávila (2013-2014). El universo estuvo constituido por la totalidad de niños entre cinco y ocho años sometidos a cirugía de urgencia. La muestra quedó conformada por 80 infantes que cumplieron los criterios de inclusión. Se administraron 5 mg/kg de ketamina 30 minutos antes de la intervención quirúrgica. Se evaluó: nivel de ansiedad antes y después de la premedicación, aceptación a la medicación, tiempo de inicio de la acción del fármaco, cooperación durante la venopunción, conducta ante la separación de los padres y reacciones adversas. Se utilizó la prueba U de Mann-Whitney para demostrar la diferencia entre variables ordinales.Resultados: antes de la premedicación prevaleció un nivel de ansiedad alto (45,0 por ciento) y después solo en una ínfima minoría (5,0 porciento) un nivel moderado. Predominaron un nivel de aceptación bueno (56,3 por ciento), un tiempo de inicio de acción del medicamento menor de cinco minutos (91,3 por ciento), cooperación del niño con la venopunción (93,3 por ciento), mayor cantidad de niños dormidos (56,3 por ciento) al ser separados de los padres para trasladar al quirófano. Solo fue reportada una reacción adversa.Conclusiones: se confirmó la utilidad de la ketamina como premedicación anestésica del paciente pediátrico ante una cirugía de urgencia(AU)
Introduction: ketamine is used as an anesthetic premedication.Objective: to evaluate the effect of premedication with intramuscular ketamine in the level of anxiety of the pediatric patient before an emergency surgery.Method: a pre-experimental study was performed with a before and after at the Provincial Hospital of Ciego de Ávila (2013-2014). The universe consisted of all children between five and eight years of age undergoing emergency surgery. The sample consisted of 80 infants who met the inclusion criteria. 5 mg/kg of ketamine was administered 30 minutes before surgery. It was evaluated: level of anxiety before and after premedication, acceptance of medication, time of onset of action of the drug, cooperation during venipuncture, behavior in the separation of parents and adverse reactions. The Mann-Whitney U test was used to demonstrate the difference between ordinal variables.Results: before premedication, a high level of anxiety prevailed (45,0 percent) and then only in a very small minority (5,0 percent) a moderate level. A good level of acceptance predominated (56,3 percent), a medication start time of less than five minutes (91,3 percent), a child's cooperation with venipuncture (93,3 percent), a greater number of sleeping children (56,3 percent) to be separated from the parents to move to the operating room. Only one adverse reaction was reported.Conclusions: the usefulness of ketamine as an anesthetic premedication of pediatric patients before emergency surgery was confirmed(AU)
Asunto(s)
Humanos , Masculino , Femenino , Medicación Preanestésica , Ketamina/administración & dosificación , Ansiedad , Cirugía General , Medicación Preanestésica/métodosRESUMEN
Cualquier acto quirúrgico crea ansiedad, sobre todo en niños, a lo que se añade la ansiedad parental por separación a la entrada al salón de operaciones.Demostrar la eficacia del midazolam jarabe para controlar la ansiedad en niños de 1-3 años que fueron sometidos a cirugía que requería anestesia general en el Hospital Provincial Pediátrico Docente Pepe Portilla de Pinar del Río, en el período 2008-2009.Se realizó estudio de cohorte, longitudinal y prospectivo de casos y controles en niños. Treinta recibieron dosis de 0.5 mg/kg de peso, y 60 controles que no lo recibieron, previo consentimiento informado de los padres. Se midió tiempo de sedación, signos vitales, reacciones adversas y grado de satisfacción de padres y personal del salón de operaciones. Se calcularon frecuencias que fueron comparadas mediante X2.La muestra resultó homogénea por sexo, edades y el tipo de cirugía a realizarse (p> 0,05). La sedación se obtuvo desde los 10 minutos en (24 niños/30). La bradipnea fue el único efecto adverso observado en 7 niños. Los controles (100 por ciento taquipneicos y llorosos). El 76.7 por ciento de los padres y el 100 por ciento del personal estuvo satisfecho con los efecto sedativos del midazolam.Es la primera vez que se usa esta droga como premedicación anestésica en niños 1-3 años, y se demuestra la eficacia y efectiva, con escasas reacciones adversas y gran aceptabilidad y satisfacción por padres y personal de salud(AU)
Any surgical procedure creates anxiety, especially in children, and also parental separation anxiety is added at the entrance to the operating room.The objective was to determine the effectiveness of midazolam syrup against anxiety in children aged 1 to 3 years old who were undergoing surgery and requiring general anesthesia, in Pepe Portilla Provincial Pediatric Teaching Hospital of Pinar del Rio, in the period 2008-2009.A prospective, longitudinal and cohort study of cases and control was carried out in children (ASA I or II). Thirty received the syrup by drops, in a dose of 0.5 mg/kg, and 60 controls who did not receive it, under informed parental consent. Sedation period, vital signs, adverse reactions and degree of satisfaction of parents and staff of the operating room were measured. Frequencies compared using the chi-square test also calculated.The sample was homogeneous by sex, age and type of surgery performed (p> 0.05). Sedation was obtained from 10 minutes on in 24 out of 30 children. Bradypnea was the only adverse effect observed with midazolam syrup in 7 children. The controls (100 percent tachypneic and crying children). 76.7% of the parents and 100 percent of the medical staff were satisfied with the sedative effect of midazolam.This is the first time this drug has been used as a premedication in children aged 1 to 3 years old, and the effectiveness and efficacy has been proved, with few adverse and wide acceptability and satisfaction by the parents and the medical staff.
Asunto(s)
Humanos , Recién Nacido , Lactante , Niño , Midazolam/uso terapéutico , Preescolar , Lactante , Ansiedad/prevención & control , Medicación Preanestésica/métodos , Estudios Longitudinales/estadística & datos numéricos , Sedación Consciente , Ansiolíticos/uso terapéuticoRESUMEN
Avaliaram-se os efeitos da acepromazina isolada ou associada ao diazepam em asininos. Cinco asininos foram submetidos a dois protocolos anestésicos: os do grupo acepromazina (AC) receberam acepromazina, 0,1mg/kg/IV, e os do grupo acepromazina-diazepam (ACD), acepromazina na mesma dose e via do AC, associada ao diazepam, 0,1mg/kg/IV. Foram mensuradas as frequências cardíaca (FC) e respiratória (FR) e a temperatura retal (TR) e analisadas variáveis eletrocardiográficas, tranquilização, período de latência, início do prolapso peniano e grau de ataxia. A tranquilização iniciou-se aos 10,4±0,9 minutos nos asininos do AC e aos 4,8±1,1 nos do ACD. Ocorreu prolapso peniano aos 4,2±1,3min no AC e aos 2,7±0,4 no ACD. A FC elevou-se aos 15 e 30min no AC. Não ocorreu variação significativa nas variáveis eletrocardiográficas e na temperatura retal. A FR diminuiu no AC a partir de 60min e no ACD a partir de 30min. A distância focinho-solo reduziu-se significativamente em ambos os grupos e nos momentos a partir de 15min. Concluiu-se que a acepromazina promove tranquilização discreta, e a adição do diazepam potencializa a tranquilização, diminui o período de latência e aumenta a ataxia.(AU)
The effects of acepromazine isolated or associated with diazepam were evaluated in five donkeys were underwent in two anesthetic protocols, in the acepromazine group (AC), animals received acepromazine (0.1mg/kg/IV) and in acepromazine-diazepam group (ACD), acepromazine at the same dose and route of AC, associated with diazepam (0.1 mg/kg/IV). Heart frequency (HR), respiratory frequency (RF) and rectal temperature (RT) were measured and electrocardiographic variables analyzed, in addition to tanquilization, latency, beginning of the penile prolapse and degree of ataxia. The tanquilization began at 10.4±0.9 minutes (min) in the AC donkeys and 4.8±1.1 in ACD. Penile prolapse occurred at 4.2±1.3 minutes in AC and 2.7±0.4 in ACD. The HR increased to 15 and 30min. Electrocardiographic parameters and rectal temperature not varied significantly. RF decreased from AC in 60min and 30min from ACD. The muzzle-to-ground distance reduced significantly in both groups and at times from 15min. It was concluded that the acepromazine promotes discreet tanquilization and the adition of diazepam potentiates the tranquilization, decreases the latency period and increases ataxia caused by acepromazine.(AU)
Asunto(s)
Animales , Diazepam/farmacología , Medicación Preanestésica/métodos , Anestesiología/métodos , Rumiantes/clasificaciónRESUMEN
Avaliaram-se os efeitos da acepromazina isolada ou associada ao diazepam em asininos. Cinco asininos foram submetidos a dois protocolos anestésicos: os do grupo acepromazina (AC) receberam acepromazina, 0,1mg/kg/IV, e os do grupo acepromazina-diazepam (ACD), acepromazina na mesma dose e via do AC, associada ao diazepam, 0,1mg/kg/IV. Foram mensuradas as frequências cardíaca (FC) e respiratória (FR) e a temperatura retal (TR) e analisadas variáveis eletrocardiográficas, tranquilização, período de latência, início do prolapso peniano e grau de ataxia. A tranquilização iniciou-se aos 10,4±0,9 minutos nos asininos do AC e aos 4,8±1,1 nos do ACD. Ocorreu prolapso peniano aos 4,2±1,3min no AC e aos 2,7±0,4 no ACD. A FC elevou-se aos 15 e 30min no AC. Não ocorreu variação significativa nas variáveis eletrocardiográficas e na temperatura retal. A FR diminuiu no AC a partir de 60min e no ACD a partir de 30min. A distância focinho-solo reduziu-se significativamente em ambos os grupos e nos momentos a partir de 15min. Concluiu-se que a acepromazina promove tranquilização discreta, e a adição do diazepam potencializa a tranquilização, diminui o período de latência e aumenta a ataxia.
The effects of acepromazine isolated or associated with diazepam were evaluated in five donkeys were underwent in two anesthetic protocols, in the acepromazine group (AC), animals received acepromazine (0.1mg/kg/IV) and in acepromazine-diazepam group (ACD), acepromazine at the same dose and route of AC, associated with diazepam (0.1 mg/kg/IV). Heart frequency (HR), respiratory frequency (RF) and rectal temperature (RT) were measured and electrocardiographic variables analyzed, in addition to tanquilization, latency, beginning of the penile prolapse and degree of ataxia. The tanquilization began at 10.4±0.9 minutes (min) in the AC donkeys and 4.8±1.1 in ACD. Penile prolapse occurred at 4.2±1.3 minutes in AC and 2.7±0.4 in ACD. The HR increased to 15 and 30min. Electrocardiographic parameters and rectal temperature not varied significantly. RF decreased from AC in 60min and 30min from ACD. The muzzle-to-ground distance reduced significantly in both groups and at times from 15min. It was concluded that the acepromazine promotes discreet tanquilization and the adition of diazepam potentiates the tranquilization, decreases the latency period and increases ataxia caused by acepromazine.
Asunto(s)
Animales , Anestesiología/métodos , Diazepam/farmacología , Medicación Preanestésica/métodos , RumiantesRESUMEN
Se realizó un estudio descriptivo, prospectivo y longitudinal en el servicio de anestesia del Hospital Provincial General Docente Universitario Carlos Manuel de Céspedes de Bayamo, Granma, desde octubre del año 2004 hasta septiembre del 2008, con el objetivo de describir el comportamiento de la medicación pre-anestésica con Midazolam por vía oral e intranasal en pacientes pediátricos. La muestra estuvo constituida por 80 pacientes. Se utilizó un muestreo sistemático, tomando como arranque el tercer número de una tabla de números aleatorios. Los resultados de la investigación señalaron una buena calidad de la sedación con la administración oral e intranasal del Midazolam (70 por ciento y 80 por ciento) respectivamente. Los parámetros vitales determinados no expusieron anormalidades importantes. La desaturación de la hemoglobina, el broncoespasmo y la depresión respiratoria constituyeron las principales complicaciones, aunque en por cientos bajos. La utilización por vía oral e intranasal constituye una alternativa útil en la premedicación del paciente pediátrico, aportando la vía intranasal mejor calidad en la sedación y menor número de complicaciones(AU)
It was performed a descriptive, prospective and longitudinal study in Anesthesia Service of Carlos Manuel de Céspedes Hospital, Bayamo, Granma, since October 2006 to September 2008, to describe the behaviour of preanesthetic medication with oral and intranasal Midazolan in pediatric patients. The sample was constituted by 80 patients. It was used a systematic sampling taking at random the third number from a table. T he results of the research showed a good quality of sedation with oral and intranasal administration of Midazolan. (70 percent-80 percent).The determined vitals parameters did not show important anomalies. The haemoglobin desaturation, the bronchospasm and respiratory depression constituted the main complications though in low percent. The application of oral and intranasal Midazolan constitutes a useful alternative in the premedication of pediatric patients where intranasal administration gives the best quality of sedation and less number of complications(EU)
Asunto(s)
Humanos , Niño , Midazolam/administración & dosificación , Medicación Preanestésica/métodos , Epidemiología Descriptiva , Estudios Prospectivos , Estudios LongitudinalesRESUMEN
PURPOSE: To evaluate the parameters of dogs anesthetized by different dissociative drugs protocols through continuous intravenous infusion. METHODS: Thirty healthy dogs of both sexes were assigned randomly to three groups (G1, G2, and G3). G1 was administered with methotrimeprazine as a pre-anesthetic medication, intravenously midazolam-ketamine as bolus for induction and midazolam-ketamine by continuous intravenous infusion for a 60 minute-period of maintenance. G2: the same as for G1. plus an increase in the midazolam dose during maintenance. G3: the same treatment as for G2, plus the addition of xylazine during maintenance. Immediately after induction the anesthetic maintenance started, and measures were taken 15 minutes after pre-medication, at 10 minutes intervals, during maintenance (M0 to M7). RESULTS: Bradycardia, atrioventricular blockage, bradypnea and hypoxemia were shown in G3. G1 and G2 showed a slight hypotension only. CONCLUSION: There were some advantages by using the continuous intravenous via: no parameters oscillation and reduction in the anesthetic recovery period. The increase in midazolam dose brought about little parametric variations which were greater when xylazine was used, with a consequent hypoxemia, bradyarrhytmia, and decrease in respiratory frequency and minute volume.
Asunto(s)
Anestésicos Combinados/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , Ketamina/administración & dosificación , Metotrimeprazina/administración & dosificación , Midazolam/administración & dosificación , Xilazina/administración & dosificación , Periodo de Recuperación de la Anestesia , Anestesia Intravenosa/métodos , Anestesia Intravenosa/veterinaria , Anestésicos Combinados/efectos adversos , Anestésicos Intravenosos/efectos adversos , Animales , Presión Sanguínea/efectos de los fármacos , Temperatura Corporal/efectos de los fármacos , Perros , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Ketamina/efectos adversos , Masculino , Metotrimeprazina/efectos adversos , Midazolam/efectos adversos , Medicación Preanestésica/métodos , Distribución Aleatoria , Factores de Tiempo , Xilazina/efectos adversosRESUMEN
La laringoscopía y la intubación traqueal constituyen un potente estímulo nociceptivo capaz de desencadenar fenómenos con un significativo aumento de la tensión arterial y de la frecuencia cardíaca. Se realizó un estudio prospectivo en 40 pacientes ASA III, con anestesia general para realizar discectomía. Fueron subdivididos en dos grupos: al Grupo B se administró clonidina 150 mcg (2.5 mcg/Kg) vía oral, 90-120 min. previos a la inducción y al Grupo A no se le administró. Se evaluaron las variables hemodinámicas basales y pos-intubación: El grupo B presentó post-intubación cifras de Tensión Arterial Sistólica y Diastólica menores con relación al grupo A (Grupo A 146 ±18 vs. 95±15 mmHg versus Grupo B 110 ± 10versus 72 ± 8 mmHg (p<0,05); la frecuencia cardiaca se elevó sólo en 11±4 latidos por minutos en dicho grupo B (p<0,05). Se requirió analgesia suplementaria en 22 por ciento de los pacientes del grupo B versus un 85 por ciento de los del grupo A. Predominó la hipertensión arterial en el grupo A (p>0,05). El uso de la clonidina fue excelente en minimizar la respuesta simpático adrenal, durante la laringoscopía e intubación traqueal. Se requirió significativamente menor analgesia suplementaria en los pacientes en que se utilizó este medicamento. No se presentaron efectos indeseables con el uso de esta droga...(AU)
Asunto(s)
Humanos , Clonidina/administración & dosificación , Intubación Intratraqueal/métodos , Laringoscopía/métodos , Medicación Preanestésica/métodosRESUMEN
JUSTIFICATIVA E OBJETIVOS: A paralisia cerebral (PC) é uma doença não progressiva decorrente de lesão no sistema nervoso central, levando a um comprometimento motor do paciente. O portador de PC freqüentemente é submetido a procedimentos cirúrgicos devido a doenças usuais e situações particulares decorrentes da paralisia cerebral. Foi objetivo deste artigo revisar aspectos da paralisia cerebral de interesse para o anestesiologista, permitindo um adequado manuseio pré, intra e pós-operatório neste tipo de paciente. CONTEUDO: O artigo aborda aspectos da paralisia cerebral como etiologia, classificação, fatores de risco, fisiopatologia, quadro clínico, diagnóstico, terapêuticas utilizadas bem como avaliação pré-operatória, medicação pré-anestésica, manuseio intra e pós-operatório, analgesia pós-operatória e dor crônica. CONCLUSÕES: O anestesiologista desempenha um papel importante na diminuição da morbidade e mortalidade anestésico-cirúrgica em pacientes portadores de paralisia cerebral. O conhecimento da fisiopatologia dos diferentes tipos de paralisia cerebral bem como das doenças associadas e suas terapêuticas é imprescindível, pois permite ao anestesiologista antecipar e prevenir complicações intra e pós-operatórias neste tipo de paciente.
Asunto(s)
Humanos , Cuidados Posoperatorios/métodos , Medicación Preanestésica/métodos , Cuidados Preoperatorios/métodos , Parálisis Cerebral/fisiopatología , Dolor CrónicoRESUMEN
Several drugs have been employed for sedation during flexible fiberoptic bronchoscopy (FOB). Clonidine attenuates stress-induced sympathoadrenal responses and has sedative properties. We investigate the effects of clonidine premedication on hemodynamic and comfort parameters of patients submitted to FOB under airway topical anesthesia only. Patients received placebo (n = 22; men = 16; median age = 50.5 years) or intravenous clonidine (3 microg/kg; n = 20; men = 15; median age = 46.0 years) 15 min before FOB. Blood pressure (BP), heart rate (HR), plasma norepinephrine (nor) and cortisol levels were measured before, during, and 1 h after FOB. Comfort was assessed by the examiner and by the patients using a visual numerical scale (0-10). The placebo group showed significant increases in systolic BP, HR, and nor levels during FOB (SBP = 125 mmHg x 145 mmHg; HR = 74 bpm x 85 bpm; nor = 316.2 pg/dl x 483.1 pg/dl), whereas clonidine group did not display such changes. Clonidine group showed a lower frequency of cardiac arrhythmias than the placebo group during and after FOB (supraventricular = 39% x 50%; ventricular = 22% x 40%). Levels of comfort were high and comparable in both groups. We concluded that although clonidine led to a somewhat better hemodynamic profile, it did not contribute to better comfort in this setting.
Asunto(s)
Analgésicos , Broncoscopía/métodos , Clonidina , Medicación Preanestésica/métodos , Simpaticolíticos , Adulto , Anciano , Presión Sanguínea/efectos de los fármacos , Método Doble Ciego , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hidrocortisona/sangre , Masculino , Persona de Mediana Edad , Dolor/prevención & controlRESUMEN
Conscious intravenous sedation is a safe alternative method to general anaesthesia. We have used a technique of continuously titrated, as opposed to incremental boluses of, intravenous or intramuscular midazolam for conscious sedation, with tumescent adrenaline-lignocaine solution for local anaesthesia, routinely in 421 plastic surgical procedures between 1997 and 2000. All patients were American Society of Anesthesiologists (ASA) class I or II. Conscious sedation was administered through our protocol of continuously titrated doses of midazolam in dextrose saline. The operative field was injected subcutaneously with varying volumes of diluted lignocaine and adrenaline, depending on the anatomical region. Preoperative sedation was administered 1 h before the procedure in the form of an intramuscular injection of pethidine and promethazine (Phenergan). Intraoperatively, a subset of patients received up to four divided diluted doses of pethidine. A preoperative 4 h starvation period pronounced the effect of the sedative. No intraoperative conversions to general anaesthesia were needed, and no sedation complications occurred. No unplanned re-admissions secondary to nausea, prolonged drowsiness or pain were required. All patients who were treated using this technique had an uneventful postoperative course. Hospital stay was substantially shorter than following general anaesthesia, which provided a significant reduction in medical-care expenses and a faster return to work. In conclusion, conscious sedation administered by titrated intravenous midazolam is a well-tolerated, safe, consistent, predictable and effective anaesthetic choice for a variety of plastic surgical procedures, many of which would commonly be performed under general anaesthesia.
Asunto(s)
Anestésicos Intravenosos/administración & dosificación , Sedación Consciente/métodos , Midazolam/administración & dosificación , Cirugía Plástica/métodos , Adolescente , Adulto , Anciano , Anestesia General/métodos , Femenino , Humanos , Masculino , Meperidina/administración & dosificación , Persona de Mediana Edad , Medicación Preanestésica/métodos , Resultado del TratamientoRESUMEN
Justificativa e Obejetivos - Verificar o efeito sedativo da clonidina, um alfa 2 - agonista, e do midazolam, um benzodiazepínico, quando utilizados na medicação pré-anestésica, empregando-se avaliação clínica e eletroencefalográfica bispectral. Método - Após aprovação institucional e consentimento escrito fornecido, 45 pacientes de 18 a 65 anos, estado físico ASA l, foram aleatoriamente distribuídos nos grupos placebo (P), clonidina (C) ou midazolam (M), em que receberam, respectivamente placebo, 150 µg de clonidina ou 15 mg de midazolam por via oral, 60 minutos antes da indução da anestesia (n = 15 por grupo). A monitorização constituiu-se de eletrocardiograma (Dll), pressão arterial não invasiva, freqüência cardíaca, saturação de pulso de oxigênio, freqüência respiratória, temperatura axiliar e da sala de cirurgia e eletroencefalograma bispectral para determinação do índice bispectral (BIS). Esses atributos e a escala de sedações (1 - ansioso, 2 - calmo, 3 - sonolento, 4 - dormindo com reflexo, 5 - dormindo sem reflexo) foram obtidos aos 0 (M0), 15 (M15), 30 (M30), 40 (M40), 50 (M50) e 60 (M60) minutos após a medicação. Resultados - Nos grupos não houve alteração significante dos parâmetros respiratórios, hemodinâmicos e de temperatura. Houve diferença significante entre os grupos na ES (M60: M=C>P) e no BIS (M50 e M60: M=C>P). Conclusões - Nas condições utilizadas, a clonidina e o midazolam determinaram níveis de sedação adequados e semelhantes na medicação pré-anestésica de pacientes estado físico ASA I, quando avaliados pela escala de sedação e pelo índice bispectral, sem determinarem alterações hemodinâmicas e respiratórias
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Temperatura Corporal , Midazolam , Monitoreo Intraoperatorio , Clonidina , Electroencefalografía , Hemodinámica , Medicación Preanestésica/métodos , Sedación Consciente , RespiraciónRESUMEN
Justificativa e Objetivos - A medicação pré-anestésica (MPA) é equivalente da anestesia e diminui tanto a necessidade de concentrações elevadas de anestésicos como a ansiedade perioperatória, produzindo amnésia e contribuindo para estabilidade hemodinâmica. Dentre as drogas administradas na MPA de crianças, encontram-se o midazolam e a clonidina. O objetivo desta pesquisa foi avaliar se a MPA com midazolam e clonidina exerce influência no nível de hipnose, avaliado pelo BIS, em crianças após indução anestésica com propofol e alfentanil. Método - Participaram do estudo 30 pacientes, com idades entre 2 e 12 anos, estado físico ASA I, submetidos a cirurgias eletivas, que foram distribuídos em 3 grupos: G1 - sem MPA, G2 - midazolam (0,5 mg.kgðû) e G3 - clonidina (4 µg.kgðû), por via oral, 60 minutos antes da cirurgia. Todos os pacientes receberam alfentanil (30 µg.kgðû), propofol (3 mg.kgðû) e atracúrio (0,5 mg.kgðû). Avaliou-se o valor derivado do BIS antes da indução da anestesia (M1) e após a intubação (M2). O método estatístico utilizado foi a análise de variância para idade, peso e altura, e análise de perfil para o BIS, sendo o valor de p < 0,05 considerado significativo. Resultados - Quando se comparou o mesmo momento (M1 ou M2) entre os três grupos, não foram observadas diferenças estatisticamente significativas. Quando se compararam os dois momentos de um mesmo grupo, M1 foi maior que M2 nos três grupos. Conclusões - A medicação pré-anestésica com midazolam e clonidina não influenciou o nível de hipnose em crianças induzidas com propofol e alfentanil
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Midazolam , Alfentanilo , Propofol , Monitoreo Intraoperatorio , Clonidina , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Anestésicos Intravenosos/administración & dosificación , Anestésicos Intravenosos/uso terapéutico , Frecuencia Cardíaca , Hipnosis Anestésica , Medicación Preanestésica/métodos , Presión ArterialRESUMEN
Introducción. El acto anestésico-quirúrgico es considerado como un factor que genera ansiedad en el paciente que será intervenido, por lo que la atención debe enfocarse a disminuir la ansiedad, con una adecuada atención hospitalaria y una consulta preanestésica eficiente, que a la vez implica la preparación psicológica y/o farmacológica del enfermo. Objetivos. Conocer y determinar las causas, la incidencia y el nivel de ansiedad preoperatoria en pacientes sometidos a cirugía electiva. Material y métodos. Estudio descriptivo, transversal, prospectivo y observacional en el que fueron evaluados 500 pacientes ASA I-II con edades de entre 18 y 65 años. La ansiedad fue evaluada mediante la aplicación de una encuesta y una escala visual análoga durante el periodo preoperatorio, 24 horas antes de la cirugía. Resultados. Predominaron los pacientes del sexo femenino, los sujetos en la cuarta década de la vida y enfermos con nivel socioeconómico medio. El 35 por ciento de los pacientes manifestaron miedo al ambiente hospitalario, 33 por ciento a la cirugía, 45 por ciento a la anestesia, 47 por ciento no conocían al cirujano y el 45 por ciento no sabían en qué consistía la cirugía que se les realizaría. Conclusión. El equipo multidisciplinario debe ofrecer orientación e información suficiente al paciente; siendo la consulta preanestésica un elemento clave para disminuir la incidencia de la ansiedad preoperatoria, para ofrecer un servicio con calidad en la práctica médica.