lunes, 12 de marzo de 2018

Sedación en niños / Pediatirc sedation

Marzo 10, 2018. No. 3018

Protocolo de sedación durante la inyección intravítrea de bevacizumab en recién nacidos prematuros con retinopatía de la prematuridad.
Sedation Protocol During Bevacizumab Intravitreal Injection in Preterm Infants With Retinopathy of Prematurity.
J Pediatr Pharmacol Ther. 2018 Jan-Feb;23(1):34-40. doi: 10.5863/1551-6776-23.1.3
OBJECTIVES: This study describes outcomes of intravenous (IV) analgesics and sedatives for bedside intravitreal bevacizumab injections for retinopathy of prematurity. METHODS: This retrospective study included infants receiving intravitreal bevacizumab injections between January 2012 and May 2016. Infants were excluded if bevacizumab was administered under general anesthesia or for incomplete records. Data collection included demographics, sedation and analgesia regimen, and cardiopulmonary adverse events (AEs). The primary objective was to identify the median doses of the IV analgesics and sedatives. The secondary objectives included the number of patients with cardiopulmonary AEs and those with procedure success, defined as procedure completion without interruption and absence of interventions. RESULTS: Fifteen infants were included. Fourteen (93.3%) were initiated on a fentanyl infusion at a median of 2 mcg/kg/hr (IQR, 2-3.6), and 12 (80%) received midazolam infusions at a median of 0.06 mg/kg/hr. All patients received at least 1 IV neuromuscular blocker dose just prior to the procedure. Only 2 patients (13.3%) required an increase in their fentanyl or midazolam infusions. Procedure success was achieved in 13 patients (86.7%). Five patients (33.3%) experienced 1 cardiopulmonary AE. One patient (6.7%) had a delay in the procedure, and 1 patient (6.7%) required naloxone. Despite this, the procedure was completed in all patients. CONCLUSIONS: Most received fentanyl and midazolam infusions with a dose of vecuronium just prior to the procedure. Thirteen (86.7%) met the criteria for procedure success. One-third experienced a cardiopulmonary AE. Future studies are needed to identify the optimal agents and route of administration for this procedure.
KEYWORDS: bevacizumab; fentanyl; midazolam; neonatal intensive care unit; retinopathy of prematurity
Resultados del tratamiento del uso de sedación por inhalación para la atención dental integral.
Treatment outcomes of using inhalation sedation for comprehensive dental care.
Eur Arch Paediatr Dent. 2018 Feb;19(1):33-37. doi: 10.1007/s40368-017-0318-4. Epub 2018 Jan 11.
AIM: To assess the outcomes of dental treatment under inhalation sedation within a UK specialist hospital setting. METHODS: This was a retrospective cohort study of the case notes of patients under 17 years of age who received dental treatment using inhalation sedation at a UK specialist setting during the period 2006-2011. Treatment outcomes were categorised into five groups: (1) treatment completed as planned, (2) modified treatment completed, (3) treatment abandoned in sedation unit and patient referred for treatment under general analgesia (GA), (4) treatment abandoned in sedation unit and patient referred for treatment under local analgesia(LA), (5) child failed to return to complete treatment. RESULTS: In total, the case notes of 453 patients were evaluated. The mean age of the patients was 10.3 ± 2.9 years. Treatment was completed successfully in 63.6% of the cases, 15.9% were referred for treatment under GA, 11.2% failed to return to complete the treatment, 7.1% received modified treatment completed, and only 2.2% were referred for treatment under LA. Treatment outcomes were significantly associated with patient`s age (p = 0.002). The treatment outcome "treatment abandoned and child referred to be treated under GA" had significantly lower mean patient ages than the other outcomes. CONCLUSIONS: The majority of children referred for inhalation sedation, completed their course of treatment. A significantly higher proportion of those in the younger age group required GA to complete their treatment.
KEYWORDS: Children; General analgesia; Inhalation sedation; Treatment outcomes
Remifentanil para sedación y analgesia durante la división despierta de colgajo de lengua en niños: un informe de dos casos.
Remifentanil for sedation and analgesia during awake division of tongue flap in children: a report of two cases.
JA Clin Rep. 2017;3(1):43. doi: 10.1186/s40981-017-0114-5. Epub 2017 Aug 23.
BACKGROUND: The tongue flap is an accepted treatment method for cleft palate repair. Orotracheal or nasotracheal intubation using a fiberoptic scope is preferred for the division of the tongue flap. We report two cases of tongue flap division in which the patients received adequate sedation and analgesia without tracheal intubation. CASE PRESENTATION: Twelve- and 13-year-old male patients were treated at our hospital for tongue flap division, performed as part of a cleft palate repair. We planned to divide the tongue flap under sedation with remifentanil (1 μg/kg/min continuous infusion) and local anesthesia, followed by induction of general anesthesia, and orotracheal intubation after the tongue flap was divided. During the procedure, patients were breathing spontaneously and were cooperative. Patients were able to follow the surgeons' verbal cues to thrust out the tongue during the procedure, so that the surgeons could easily insert the sutures. CONCLUSIONS: During the division of the tongue flap in two children, excellent sedative and analgesic effects were achieved using continuous remifentanil infusion.
KEYWORDS: Cleft palate; Remifentanil; Tongue flap
Curso Regional de Anestesiología en Obstetricia y Pediatría
Colegio de Anestesiólogos de León AC y FMCA, AC
Mayo 17-19, 2018. León Guanajuato, México
Informes con el Dr. Enrique Hernández Cortez
Safe Anaesthesia Worldwide
Delivering safe anaesthesia to the world's poorest people
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