Evaluación del efecto de la actuación de los payasos de hospital sobre la ansiedad, en los niños sometidos a una intervención quirúrgica / Evaluation of the effect of hospital clown´s performance about anxiety in children subjected to surgical intervention

Introducción. Ser hospitalizado es un acontecimiento altamente angustioso para los niños. Actualmente un recurso usado en España y otros países para reducir la ansiedad de los niños en el contexto sanitario son los payasos de hospital. Estudiamos el efecto de los payasos de hospital sobre la ansiedad en los niños que van a ser operados. Método. Reclutamos a 60 niños de entre 6 y 10 años de edad, que iban a ser sometidos a una cirugía electiva. 30 niños tendrían payasos antes de la cirugía (grupo de casos) y 30 no los tendrían (grupo control).En el grupo de casos, 2 payasos actuaron para los niños. Medimos la ansiedad con distintas escalas (STAIC, CCPH, escala de caras), después de la actuación y hasta 7 días después de la cirugía. Resultados. Los resultados muestran que ambos grupos tienen una tendencia a incrementar la ansiedad, pero los niños del grupo de casos mostraron menos incremento en la puntuación de ansiedad. El grupo control mostró que los niños están más alterados a los siete días del alta. Conclusiones. Los niños que reciben la atención de los payasos tienen tendencia a estar menos estresados y con menos miedo que los otros, medido por el STAIC y la escala de caras, y estos resultados se mantienen siete días después del alta (AU)

Objective. To be hospitalized is a highly distressing event for children. At present, a resort used in Spain and other countries to reduce children’s anxiety in the health context are hospital’s clown. We studied the effect of the hospital’s clowns about the anxiety in children that going to be operated. Methods. We recruited 60 children aged 6 to 10 years scheduled to undergo elective surgery. 30 children would have clowns before the surgery (case group) and 30 would not have them (control group).In the case group, two clowns performed for children. We measured the anxiety with several scales (STAIC, CCPH, faces scale), after the performance and until 7 days after the surgery. Results. The outcomes show both groups a tendency to increase anxiety but the children of the case group showed less increase at the anxiety’s score. In the control group is showed that the children are more alterated at seven days from the discharge. Conclusions. Children that receive the clown’s care, have tendency to be less distressing and with less fear that another ones, measurement by STAIC and faces scale, and these results are maintained seven days after the discharge (AU)

[Infant boy with propionic acidemia: anesthetic implications]. / Implicaciones anestésicas en un niño afecto de acidemia propiónica.

A 12-month-old boy diagnosed with propionic acidemia underwent gastrostomy. The patient's general state was good and he was alert, but with reduced muscular tone (unstable when seated with support, floppy head) and with dystonic movements in all extremities. An electroencephalogram showed slightly slowed brain activity. The patient was being treated with a low protein diet, phenobarbital, L-carnitine, L-isoleucine, and biotin. Surgery was carried out in satisfactory conditions with general anesthesia without opioids combined with infiltration of the surgical wound with local anesthetic. Recovery from anesthesia was rapid and free of complications. Propionic acidemia is caused by mitochondrial propionyl coenzyme carboxylase deficiency. Most patients have episodes of severe metabolic ketoacidosis as a result of excessive protein intake, delayed development, vomiting, gastroesophageal reflux, lethargy, hypotonia, and convulsions. The anesthetic approach involves avoiding triggers of metabolic acidosis (such as fasting, dehydration, hypoxemia, and hypotension) and preventing airway complications. Agents that metabolize propionic acid (such as succinylcholine, benzylisoquinoline neuromuscular blocking agents, and propofol) are not used, as they can exacerbate acidemia. We also believe that using local or regional anesthesia in combination with general anesthesia without opiates is safe and effective for controlling pain during surgery and postoperative recovery, as that combination avoids respiratory depression in these patients, who are highly sensitive to opiates.

Implicaciones anestésicas en un niño afecto de acidemia propiónica / Infant boy with propionic acidemia: anesthetic implications

Un niño de 12 meses de edad con diagnóstico de acidemia propiónica fue intervenido para gastrostomía. El paciente presentaba buen estado general y sensorio despejado, tono muscular disminuido, sedestación inestable con apoyo, sostén cefálico incompetente y movimientos distónicos de las cuatro extremidades. El EEG mostraba una actividad bioeléctrica cerebral discretamente enlentecida. El paciente estaba siendo tratado con dieta hipoproteica, fenobarbital, L-carnitina, L-isoleucina y biotina. La cirugía fue realizada bajo anestesia general sin opioides combinada con infiltración de la herida quirúrgica con anestésico local, que proporcionó condiciones quirúrgicas satisfactorias y una recuperación de la anestesia rápida y sin complicaciones. La acidemia propiónica se produce como consecuencia de la actividad deficiente de la enzima mitocondrial propionilCo-A carboxilasa. La mayoría de los pacientes presentan episodios de cetoacidosis metabólica severa secundaria a la excesiva ingesta proteica, retraso del desarrollo, vómitos, reflujo gastroesofágico, letargia, hipotonía y crisis convulsivas. La conducta anestésica se dirige a evitar los precipitantes de acidosis metabólica (ayuno, deshidratación, hipoxemia e hipotensión arterial) y las complicaciones de la vía aérea, así como no utilizar agentes anestésicos que se metabolizan a ácido propiónico como la succinilcolina, bloqueantes neuromusculares bencilisoquinoleínicos y el propofol, ya que pueden contribuir a la acidemia. Además, consideramos que el empleo de anestesia locorregional combinada con anestesia general sin opioides es segura y efectiva para el control del dolor durante la intervención y en el postoperatorio, ya que evitaría la depresión respiratoria en estos pacientes con elevada sensibilidad a los opioides

A 12-month-old boy diagnosed with propionic acidemia underwent gastrostomy. The patient's general state was good and he was alert, but with reduced muscular tone (unstable when seated with support, floppy head) and with dystonic movements in all extremities. An electroencephalogram showed slightly slowed brain activity. The patient was being treated with a low protein diet, phenobarbital, L-carnitine, L-isoleucine, and biotin. Surgery was carried out in satisfactory conditions with general anesthesia without opioids combined with infiltration of the surgical wound with local anesthetic. Recovery from anesthesia was rapid and free of complications. Propionic acidemia is caused by mitochondrial propionyl coenzyme carboxylase deficiency. Most patients have episodes of severe metabolic ketoacidosis as a result of excessive protein intake, delayed development, vomiting, gastroesophageal reflux, lethargy, hypotonia, and convulsions. The anesthetic approach involves avoiding triggers of metabolic acidosis (such as fasting, dehydration, hypoxemia, and hypotension) and preventing airway complications. Agents that metabolize propionic acid (such as succinylcholine, benzylisoquinoline neuromuscular blocking agents, and propofol) are not used, as they can exacerbate acidemia. We also believe that using local or regional anesthesia in combination with general anesthesia without opiates is safe and effective for controlling pain during surgery and postoperative recovery, as that combination avoids respiratory depression in these patients, who are highly sensitive to opiates

[Post-surgical paediatric pain: Nursing- PCA vs continuous I.V. infusion of tramadol ]. / Dolor postoperatorio en lactantes y niños pequeños: nursing-PCA vs perfusión i.v. de tramadol.

AIM: To evaluate the efficiency in the control of the post-surgical paediatric pain of the combination of a weak opioid [tramadol (T)] and an NSAID (paracetamol), comparing its administration through "Nursing-PCA" (NCA) techniques or through continuous i.v. infusion. METHODS: The investigation has been carried out in 30 patients (mean 9.5 months) selected according to their foreseeable degree of moderate-hard pain. All of them consumed in the postoperative period: rectal paracetamol (20 mg/Kg) every 8 hours and tramadol in two groups. Group I: PCA pump with tramadol that was handled by the nurse. Initial dose: 0.5 mg/Kg NCA, bolus injection 0.3 mg/Kg with an interval of 10 minutes for security and a highest dose of 1.2 mg/Kg/4 h every 4 hours. Group II: continuous infusion i.v. of tramadol (6 mg/Kg/24 h). The pain was evaluated, as well as the sedative action, saturation oxygen, respiratory and hemodynamics parameters, adverse effects, and efficiency during the first 24 hours, as well as the number of total dose of drugs asked in the Nursing PCA group. RESULTS: Pain decreased in both groups. There were more sedative effects in group II and the total dose of tramadol was higher. There were no cases of respiratory depression. CONCLUSIONS: The combination of tramadol and paracetamol through "Nursing PCA" has turned out to be an efficient method in the treatment of the post-surgical pain in little children and those whose are in their lacteal period. It is a possible alternative of the continuous infusion of Morphine in these patients.

Dolor postoperatorio en lactantes y niños pequeños: Nursing-PCA vs perfusión I.V. de tramadol / Post-surgical paediatric pain: Nursing-pca vs continuous i.v. infusion oftramadol

Objetivos. Evaluar la eficacia en el control del dolor postoperatorio pediátrico de la asociación de un opiáceo menor [tramadol(T) ] y un AINE (paracetamol), comparando su administración mediante técnicas de «Nursing-PCA» (NCA) o mediante infusión I.V. continua. Material y métodos. Se han estudiado 30 pacientes ASA I, de edad media 9,5 meses, seleccionados según el grado previsible de dolor moderado-severo. Todos reciben en el postoperatorio: Paracetamol 20mg/Kg rectal cada 8 horas y Tramadol en dos grupos. Grupo I: Bomba PCA con Tramadol (dosis de inicio: 0,5 mg/Kg-NCA bolo 0,3 mg/Kg con un intervalo de seguridad 10 minutos y dosis máxima cada 4 horas de 1,2 mg/Kg/4h), que se accionó por enfermería. Grupo II: Perfusión IV de Tramadol (6 mg/Kg/24h). Se evaluó dolor, sedación, saturación de O2, frecuencia respiratoria, parámetros hemodinámicos, efectos (..) (AU)