Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942011000100005
Brazilian Journal of Anesthesiology
Scientific Article

Anestesia intraóssea em estudo hemodinâmico em criança cardiopata

Intraosseous anesthesia in hemodynamic studies in children with cardiopathy

Ana Cristina Aliman; Marilde de Albuquerque Piccioni; João Luiz Piccioni; José Luiz Oliva; José Otávio Costa Auler Júnior

http://dx.doi.org/10.1590/S0034-70942011000100005 Braz J Anesthesiol, vol.61, n1, p.45-49, 2011
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Resumo

JUSTIFICATIVA E OBJETIVOS: O acesso intraósseo (IO) tem sido utilizado com bons resultados em situações de emergência quando não há acesso venoso disponível para a administração de fluidos e fármacos. O objetivo do presente estudo foi avaliar se o acesso IO é uma técnica útil para a administração de anestesia e fluidos no estudo hemodinâmico quando é impossível obter acesso periférico. Este estudo foi realizado na Unidade de Hemodinâmica de um hospital universitário, com 21 lactentes que apresentavam doença cardíaca congênita agendados para estudo hemodinâmico diagnóstico. MÉTODOS: Este estudo comparou a efetividade do acesso IO em relação ao EV para a infusão de anestésicos (cetamina, midazolam e fentanil) e fluidos durante estudo hemodinâmico. Tempo de indução anestésica, duração do procedimento, tempo de recuperação da anestesia, hidratação e complicações das punções EV e IO foram comparados entre os grupos. RESULTADOS: O tempo de punção foi significativamente menor no grupo IO (3,6 minutos) do que no grupo EV (9,6 minutos). O tempo de início da ação do anestésico foi mais rápido no grupo EV (56,3 segundos) do que no grupo IO (71,3 segundos). Não foram observadas diferenças significativas entre os dois grupos em relação à hidratação (grupo EV 315,5 mL vs. grupo IO 293,2 mL) e o tempo de recuperação da anestesia (grupo IO 65,2 min vs grupo EV 55,0 min). O sítio da punção foi reavaliado após 7 e 15 dias, não apresentando sinais de infecção ou outras complicações. CONCLUSÕES: Os resultados demonstraram superioridade da infusão IO em relação ao tempo de punção. Devido à sua manipulação bastante fácil e à sua eficiência, a hidratação e a anestesia feitas através de infusão IO se revelaram satisfatórias para estudos hemodinâmicos sem a necessidade de outros acessos.

Palavras-chave

ANESTESIA, Pediátrica, ANESTÉSICO, Local, intraósseo, DOENÇA, DOENÇA, TÉCNICAS ANESTESICAS, Geral, TECNICAS DE MEDIÇÃO, Hemodinâmica

Abstract

BACKGROUND AND OBJECTIVES: Intraosseous (IO) access has been used with good results in emergency situations, when venous access is not available for fluids and drugs infusion. The objective of this study was to evaluate IO a useful technique for anesthesia and fluids infusion during hemodynamic studies and when peripheral intravascular access is unobtainable. The setting was an university hospital hemodynamics unit, and the subjects were twenty one infants with congenital heart disease enrolled for elective hemodynamic study diagnosis. METHODS: This study compared the effectiveness of IO access in relation to IV access for infusion of anesthetics agents (ketamine, midazolam, and fentanyl) and fluids during hemodynamic studies. The anesthetic induction time, procedure duration, anesthesia recovery time, adequate hydration, and IV and IO puncture complications were compared between groups. RESULTS: The puncture time was significantly smaller in IO group (3.6 min) that in IV group (9.6 min). The anesthetic onset time (56.3 second) for the IV group was faster than IO group (71.3 second). No significant difference between groups were found in relation to hydration (IV group, 315.5 mL vs IO group, 293.2 mL), and anesthesia recovery time (IO group, 65.2 min vs IV group, 55.0 min). The puncture site was reevaluated after 7 and 15 days without signs of infection or other complications. CONCLUSIONS: Results showed superiority for IO infusion when considering the puncture time of the procedure. Due to its easy manipulation and efficiency, hydration and anesthesia by IO access was satisfactory for hemodynamic studies without the necessity of other infusion access.

Keywords

Infusions, Intraosseous, Heart Defects, Congenital, Anesthesia, Angiography, Hemodynamics

Referencias

Tocantins LM, O'Neill JF, Jones HW. Infusions of blood and other fluids via the bone marrow: applications in pediatrics. JAMA. 1941;117:1229-1234.

Cournand J. Technique for insertion of plastic catheter into saphenous vein. Pediatrics. 1941;24:631-637.

Begg AC. Intraosseous venography of the lower limb and pelvis. Br J Radiol. 1954;27:318-324.

Engle WA. Intraosseous access for administration of medications in neonates. Clin Perinatol. 2006;33:161-168.

Smith R, Davis N, Bouamra O. The utilisation of intraosseous infusion in the resuscitation of paediatric major trauma patients. Injury. 2005;36:1034-1038.

Mackway-Jones KME, Phillips B, Wieteska S. Intraosseous transfusion. Advanced Paediatric Life Support. 2001:229-230.

2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care: International consensus on science. Circulation. 2005;112:iv12-iv211.

Brown K, Lightfoot C. The 2005 Guidelines for CPR and Emergency Cardiovascular Care: Implications for Emergency Medical Services for Children. Clin Ped Emerg Med. 2006;7:105-113.

Goresky GV, Maltby JR. Fasting guidelines for elective surgical patients. Can J Anaesth. 1990;37:493-495.

Green SM, Johnson NE. Ketamine sedation for pediatric procedures: Part 2 - Review and implications. Ann Emerg Med. 1990;19:1033-1046.

Haas NA. Clinical review: vascular access for fluid infusion in children. Crit Care. 2004;8:478-484.

Iserson KV, Criss EA. Pediatric venous cutdowns: utility in emergency situations. Pediatr Emerg Care. 1986;2:231-234.

Westfall MD, Price KR, Lambert M. Intravenous access in the critically ill trauma patient: a multicentered, prospective, randomized trial of saphenous cutdown and percutaneous femoral access. Ann Emerg Med. 1994;23:541-545.

Seah TG, Chin NM. Severe laryngospasm without intravenous access: a case report and literature review of the non-intravenous routes of administration of suxamethonium. Singapore Med J. 1998;39:328-330.

Helm M, Hauke J, Bippus N. Die intraossare Punktion in der praklinischen Notfallmedizin: 10-jahrige Erfahrungen im Luftrettungsdienst. Anaesthesist. 2007;56:18-24.

Buck ML, Wiggins BS, Sesler JM. Intraosseous drug administration in children and adults during cardiopulmonary resuscitation. Ann Pharmacother. 2007;41:1679-1686.

Banerjee S, Singhi SC, Singh S. The intraosseous route is a suitable alternative to intravenous route for fluid resuscitation in severely dehydrated children. Indian Pediatr. 1994;31:1511 -1520.

Brickman KR, Krupp K, Rega P. Typing and screening of blood from intraosseous access. Ann Emerg Med. 1992;21:414-417.

Fiser RT, Walker WM, Seibert JJ. Tibial length following intraosseous infusion: a prospective, radiographic analysis. Pediatr Emerg Care. 1997;13:186-188.

Ummenhofer W, Frei FJ, Urwyler A. Are laboratory values in bone marrow aspirate predictable for venous blood in paediatric patients?. Resuscitation. 1994;27:123 -128.

Guy J, Haley K, Zuspan SJ. Use of intraosseous infusion in the pediatric trauma patient. J Pediatr Surg. 1993;28:158-161.

Macnab A, Christenson J, Findlay J. A new system for sternal intraosseous infusion in adults. Prehosp Emerg Care. 2000;4:173 -177.

Ellemunter H, Simma B, Trawoger R. Intraosseous lines in preterm and full term neonates. Arch Dis Child Fetal Neonatal Ed. 1999;80:F74 -F75.

The International Liaison Committee on Resuscitation (ILCOR) consensus on science with treatment recommendations for pediatric and neonatal patients: pediatric basic and advanced life support. Pediatrics. 2006;117(5):955-977.

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