Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942001000500004
Brazilian Journal of Anesthesiology
Scientific Article

Dor a injeção venosa de propofol em crianças: efeitos da adição de lidocaína e da inalação de óxido nitroso

Pain after propofol intravenous injection in children: effects of combined lidocaine and inhalational nitrous oxide

Artur Udelsmann; Waston V Silva; Virgínia Maia da Conceição; Rosa Inês Costa Pereira

http://dx.doi.org/10.1590/S0034-70942001000500004 Braz J Anesthesiol, vol.51, n5, p.394-400, 2001
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Resumo

JUSTIFICATIVA E OBJETIVOS: O meio hospitalar tem inúmeros fatores de apreensão e medo para as crianças. Entre eles injeções venosas são um dos mais importantes, principalmente se dolorosas. Propofol tem sido largamente utilizado para a indução da anestesia, mas tem o inconveniente de causar dor à injeção. O objetivo deste estudo foi comparar dois métodos de analgesia para a injeção venosa de propofol em crianças. MÉTODO: Sessenta e nove crianças admitidas ao centro cirúrgico para procedimentos de rotina sob anestesia geral, previamente com uma via venosa instalada no dorso de uma das mãos, foram aleatoriamente divididas em quatro grupos. No grupo 1, as crianças inalaram previamente, durante 2 minutos, O2 e a indução foi feita somente com propofol. No grupo 2, inalaram O2 e a cada 90 mg de propofol foram acrescentados 10 mg de lidocaína na forma de solução a 1%. No grupo 3, as crianças inalaram N2O 66% e O2 33% e o propofol foi usado puro. No grupo 4, os dois métodos foram combinados: as crianças inalaram N2O 66% com O2 33% e a indução foi feita com propofol diluído com lidocaína. A dor à indução foi avaliada, assim como a freqüência cardíaca antes e após a injeção. RESULTADOS: O grupo 4 foi o único no qual não se observou alteração da freqüência cardíaca após a injeção de propofol. No grupo 1, as crianças apresentaram mais dor e no grupo 4 tiveram menos. No grupo 2, a analgesia não foi suficiente e no grupo 3 houve somente uma tendência estatística à analgesia. CONCLUSÕES: Nas condições deste estudo, a inalação prévia de N2O antes da injeção venosa de propofol associado à lidocaína mostrou ser o método de analgesia mais eficaz para a indução da anestesia geral com propofol em crianças.

Palavras-chave

ANESTÉSICOS, Inalatório, Local, HIPNÓTICOS, TÉCNICAS ANESTÉSICAS, Venosa

Abstract

BACKGROUND AND OBJECTIVES: Hospital settings are stressful and fearful for children. Intravenous injections are mostly feared, especially if painful. Propofol is widely used for anesthesia induction but has the disadvantage of pain. This study aimed to compare two analgesic methods for intravenous propofol injection in children. METHODS: Participated in this study 69 pediatric patients admitted for routine procedures under general anesthesia, with an intravenous line on the back of one hand, who were randomly allocated into four groups. Group 1 received previous inhalational O2 for 2 minutes and anesthesia was induced with propofol only. Group 2 inhaled O2 and to each 90 mg of propofol 10 mg of 1% lidocaine were added. Group 3 inhaled 66% N2O and 33% O2 and anesthesia was induced with propofol alone. Group 4 received a combination of both methods: children inhaled 66% N2O with 33% O2 and anesthesia was induced with propofol combined with lidocaine. Pain on induction and heart rate before and after injection were evaluated. RESULTS: Group 4 was the only one with no changes in heart rate after propofol injection. Group 1 had more pain on induction and group 4 had less. Analgesia was insufficient for group 2, and group 3 has only shown a statistical trend to analgesia. Conclusions: Dilution with lidocaine combined with N2O inhalation before intravenous propofol injection showed to be the most efficient method of analgesia for propofol induction in children.

Keywords

ANESTHETICS, Inhalational, Local, ANESTHETIC TECHNIQUES, Intravenous, HYPNOTICS

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