Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942004000200010
Brazilian Journal of Anesthesiology
Clinical Information

Conduta anestésica em balneoterapia de pacientes queimados: avaliação prospectiva de 2852 procedimentos

Anesthetic procedure for balneotherapy of burned patients: prospective evaluation of 2852 cases

Fernando Antônio de Freitas Cantinho; Fernando Guedes Santos; Antônio Carlos Pereira da Silva

http://dx.doi.org/10.1590/S0034-70942004000200010 Braz J Anesthesiol, vol.54, n2, p.229-238, 2004
PDF Português
PDF English
Downloads: 1
Views: 1287

Resumo

JUSTIFICATIVA E OBJETIVOS: A analgesia profunda no paciente queimado, que necessita de cuidados diários das lesões, constitui um campo de atuação do anestesiologista em que as referências de conduta ainda são muito escassas. O objetivo deste estudo foi avaliar a conduta anestésica em balneoterapia de pacientes queimados em 2852 procedimentos. MÉTODO: Foi realizada avaliação prospectiva das alternativas de analgesia e sedação empregadas por anestesiologistas, no período de 1 ano. Idade, peso, sexo, superfície corporal queimada (SCQ), drogas e doses empregadas, duração, monitorização, número de procedimentos por paciente e complicações foram registrados. Para a análise dos resultados, a amostra foi dividida em grupos: grupo A, com idade até 10 anos; grupo B, 11 a 17 anos; grupo C, 18 a 65 anos; grupo D, acima de 65 anos e os dados foram comparados. RESULTADOS: Foram 2852 procedimentos realizados em 134 pacientes. No grupo A, foram 743 procedimentos em 42 pacientes; no grupo B, 354 procedimentos em 16 pacientes; no grupo C, 1573 procedimentos em 68 pacientes; no grupo D, 182 procedimentos em 8 pacientes. Em toda a amostra, a S(+)-cetamina por via venosa, como agente único, foi usada em 116 casos. A S(+)-cetamina, associada ao midazolam, por via venosa, foi usada em 631 casos. A S(+)-cetamina, associada ao midazolam e ao fentanil, por via venosa, foi usada em 1562 casos. A S(+)-cetamina por via muscular, como agente único, foi empregada em 188 casos, sendo 173 no grupo A. O propofol foi associado em outros 149 casos. A cetamina racêmica foi usada em mais 142 casos. O alfentanil, como alguns outros agentes, foi pouco usado. A duração dos procedimentos foi de 29,3 ± 10,6 minutos; maior peso e SCQ se correlacionaram com aumento significante da duração. Houve 30 casos de diminuição da SpO2 abaixo de 90%, sendo 3 casos (0,59%) no subgrupo que recebeu S(+)-cetamina e midazolam por via venosa, e 24 casos (1,93%) no que recebeu S(+)-cetamina, midazolam e fentanil pela mesma via (p = 0,039). Houve um caso de parada cardíaca em paciente moribundo, que foi recuperado, prosseguindo-se o banho até o final. CONCLUSÕES: A S(+)-cetamina, o midazolam e o fentanil foram os agentes mais empregados, sendo a S(+)-cetamina o principal agente. As técnicas anestésicas empregadas mostraram-se seguras e eficazes.

Palavras-chave

ANESTESIA, TERAPÊUTICA

Abstract

BACKGROUND AND OBJECTIVES: Deep analgesia of burned patients needing daily care of their injuries is a field where references are very scarce in the literature. This study aimed at evaluating balneotherapy anesthetic technique in 2852 procedures. METHODS: A one-year period prospective evaluation was performed on sedative and analgesic alternatives adopted by anesthesiologists. Age, weight, gender, burned surface area (BSA), drugs and doses used, duration, monitoring, number of sessions by patient, and complications were recorded. Samples was divided in four groups according to age: group A, < 10 years; group B, 11 to 17 years; group C, 18 to 65 years; group D, > 65 years, and the results were compared. RESULTS: There have been 2852 balneotherapy sessions performed in 134 patients: Group A = 743 sessions in 42 patients; Group B = 354 sessions in 16 patients; Group C = 1573 sessions in 68 patients; Group D = 182 sessions in 8 patients. Throughout the study, the intravenous S(+)-ketamine as single agent was used in 116 sessions. The intravenous S(+)-ketamine with midazolam was used in 631 sessions. The intravenous S(+)-ketamine with midazolam and fentanyl was used in 1562 sessions. The muscular S(+)-ketamine as single agent was used in 188 sessions, being 173 in group A. The propofol was associated in 149 sessions. The racemic ketamine was used in 142 sessions. The alfentanil, as some other agents, was seldom used. Sessions lasted 29.3 ± 10.6 minutes and the increased weight and/or BSA was correlated to significantly longer sessions. There have been 30 cases of SpO2 below 90%, being 3 cases (0.59%) in patients receiving intravenous S(+)-ketamine and midazolam, and 24 cases (1.93%) in patients receiving intravenous S(+)-ketamine, midazolam and fentanyl (p = 0.039). There has been one case of cardiac arrest in moribund patient, who was resuscitated and the session was completed. CONCLUSIONS: The S(+)-ketamine, midazolam and fentanyl were the most common agents, being the S(+)-ketamine the major agent. Anesthetic techniques were safe and effective.

Keywords

DOENÇAS, ANESTHESIA, DISEASES, THERAPY

References

MacLennan N, Heimbach DM, Cullen BF. Anesthesia for major thermal injury. Anesthesiology. 1998;89:749-770.

Lewis SM, Clelland JA, Knowles CJ et al. Effects of auricular acupuncture-like transcutaneous electric nerve stimulation on pain levels following wound care in patients with burns: a pilot study. J Burn Care Rehabil. 1990;11:322-329.

Hernandez-Reif RM, Field T, Largie S. Children's distress during burn treatment is reduced by massage therapy. J Burn Care Rehabil. 2001;22:191-195.

Landolt MA, Marti D, Widmer J. Does cartoon movie distraction decrease burned children's pain behavior?. J Burn Care Rehabil. 2002;23:61-65.

Patterson DR, Questad KA, Lateur BJ. Hypnotherapy as an adjunct to narcotic analgesia for the treatment of pain for burn debridement. Am J Clin Hypn. 1989;31:156-163.

Foertsch CE, O'Hara MW, Stoddard FJ. Parent participation during burn debridement in relation to behavioral distress. J Burn Care Rehabil. 1996;17:372-377.

Frenay MC, Faymonville ME, Devlieger S. Psychological approaches during dressing changes of burned patients: a prospective randomised study comparing hypnosis against stress reducing strategy. Burns. 2001;27:793-799.

Wright BR, Drummond PD. Rapid induction analgesia for the alleviation of procedural pain during burn care. Burns. 2000;26:275-282.

Serra MC, Gomes DR. Analgesia nos Pacientes Queimados. Anais do VII Congresso Brasileiro de Medicina Intensiva Adulto e Pediátrico. 1995;P-078:22-26.

Gallagher G, Rae CP, Kenny GN. The use of a target-controlled infusion of alfentanil to provide analgesia for burn dressing changes: A dose finding study. Anaesthesia. 2000;55:1159-1163.

Hansen SL, Voigt DW, Paul CN. A retrospective study on the effectiveness of intranasal midazolam in pediatric burn patients. J Burn Care Rehabil. 2001;22:6-8.

Carsin H. Use of diprivan in burn patients. Ann Fr Anesth Reanim. 1994;13:541-544.

Santos RA, Oliveira ASN, Serra MCVS. Associação propofol/cetamina para banho/curativo em queimado. Rev Bras Anestesiol. 1997;47(^s22):CBA014.

Malek J, Simankova E, Kurzova A. Sevoflurane vs ketamine in adult burn patients: a controlled study. Eur J Anaesthesiol. 2001;18:(Suppl 21):11.

Groeneveld A, Inkson T. Ketamine: A solution to procedural pain in burned children. Can Nurse. 1992;88:28-31.

Pal SK, Cortiella J, Herndon D. Adjunctive methods of pain control in burns. Burns. 1997;23:404-412.

Maldini B. Ketamine anesthesia in children with acute burns and scalds. Acta Anaesthesiol Scand. 1996;40:1108-1111.

Arendt-Nielsen L, Nielsen J, Petersen-Felix S. Effect of racemic mixture and the (S+)-isomer of ketamine on temporal and spatial summation of pain. Br J Anaesth. 1996;77:625-631.

Lauretti GR, Lima ICPR, Buscatti RY. Avaliação clínica dos efeitos hemodinâmicos, analgésicos, psicodélicos e do bloqueio neuromuscular da cetamina racêmica e de seu S(+) isômero. Rev Bras Anestesiol. 2000;50:357-362.

Pfenninger EG, Durieux ME, Himmelseher S. Cognitive Impairment after small-dose ketamine isomers in comparison to equianalgesic racemic ketamine in human volunteers. Anesthesiology. 2002;96:357-366.

5dd7f22e0e88252d0813f287 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections