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Sedación y analgesia para procedimientos pediátricos fuera del pabellón
Ronco M.,Ricardo; Castillo M.,Andrés; Carrasco,Juan; Carrasco,Claudio; Parraguez T.,Rosita; Zamora Z.,Macarena; Rodríguez C.,José;
Revista chilena de pediatría , 2003, DOI: 10.4067/S0370-41062003000200005
Abstract: there are an increasing number of children requiring sedation and analgesia for invasive procedures, the majority of which are performed in the operating room (or). objectives: we prospectively studied the efficacy, safety and costs involved in the sedation and analgesia of different invasive procedures in children performed outside the or. hypothesis: the use of short acting sedatives allows the performance of invasive procedures outside of the or in a safe and cost effective manner. patients and methods: we included children older than 1 month, outside of the itu who required sedation for invasive procedures. propofol was used alone or with other sedatives. dose, side-effects, quality of sedation and cost were compared with that in the or. results: in 51 procedures carried out on 51 children, in 30/51 patients propofol was the only sedative used. the average total dose of propofol was 3.6 mg/kg, there were no differences in propofol dose when used alone or with other sedatives. the median recovery time was 20 min, range 4-45 min. using a 1-10 scale, the quality of sedation was assessed, with a median of 10, range 7-10. 16 untoward effects occurred in 13 patients, the commonest was respiratory depression in 8, these events were self limited and of short duration. the cost of the procedure was 6 times lower ($ 14 000) as compared to using the or and recovery room ($ 90 000), and the overall time for the procedure performed was shorter 40 minutes vs 3 hours. conclusions: the use of sedation and analgesia to permit the use of procedures outside the or is safe and effective, decreasing costs and hospital time. propofol was a good alternative as a sedative drug in these patients
Procedural sedation analgesia  [cached]
Sheta Saad
Saudi Journal of Anaesthesia , 2010,
Abstract: The number of noninvasive and minimally invasive procedures performed outside of the operating room has grown exponentially over the last several decades. Sedation, analgesia, or both may be needed for many of these interventional or diagnostic procedures. Individualized care is important when determining if a patient requires procedural sedation analgesia (PSA). The patient might need an anti-anxiety drug, pain medicine, immobilization, simple reassurance, or a combination of these interventions. The goals of PSA in four different multidisciplinary practices namely; emergency, dentistry, radiology and gastrointestinal endoscopy are discussed in this review article. Some procedures are painful, others painless. Therefore, goals of PSA vary widely. Sedation management can range from minimal sedation, to the extent of minimal anesthesia. Procedural sedation in emergency department (ED) usually requires combinations of multiple agents to reach desired effects of analgesia plus anxiolysis. However, in dental practice, moderate sedation analgesia (known to the dentists as conscious sedation) is usually what is required. It is usually most effective with the combined use of local anesthesia. The mainstay of success for painless imaging is absolute immobility. Immobility can be achieved by deep sedation or minimal anesthesia. On the other hand, moderate sedation, deep sedation, minimal anesthesia and conventional general anesthesia can be all utilized for management of gastrointestinal endoscopy.
Sedoanalgesia pediátrica en lugares fuera de quirófano Pediatric sedoanalgesia outside the operating theatre  [cached]
M. Castilla-Moreno,M. Castilla-García
Revista de la Sociedad Espa?ola del Dolor , 2004,
Abstract: Objetivo: Analizar las sedaciones que se realizan en pediatría, fuera del área quirúrgica. Esto siempre es un reto para el anestesiólogo pero más si los pacientes son ni os. Creemos que una de las claves es tener protocolizados los fármacos a utilizar y sus vías de administración, la monitorización, tener una enfermera dedicada a ayudar al anestesiólogo y por supuesto seleccionar muy bien los procedimientos; de hecho, a pesar de los muchos trabajos que hay publicados sobre sedación, muchas de ellas fracasan por no estar bien indicadas o porque el personal que la realiza no es un anestesiólogo. Nuestro método de trabajo fue: -Hacer una búsqueda bibliográfica sobre un fármaco básico: propofol. -En cuanto a los procedimientos a realizar bajo sedación en ni os, contactamos con varios hospitales de gran reconocimiento en el mundo de la Anestesia Pediátrica con una lista de dichos procedimientos. Los hospitales consultados fueron: Children's Hospital de Pittsburgh, Cleveland Clinic Foundation, Departamento de Anestesia Pediátrica de la Universidad de Varsovia, Children's Hospital de Colonia (Alemania), Sick Great Ormond Street de Londres; todos coinciden en seguir los siguientes pasos: ba o del ni o quemado, radioterapia, resonancia nuclear magnética (RNM), tomografía axial computerizada (TAC) y tomografía de emisión de positrones (PET). La ecocardiografía en ni os peque os se realiza la mayor parte con hidrato de cloral, bien por vía oral (85%) o rectal. Material y método: Se revisa literatura reciente mediante buscadores de internet, destacando que la mayoría emplean propofol; se cruzan palabras claves: propofol and children, propofol and infants y propofol and neonates. Conclusiones: Los procedimientos de sedación en ni os necesitan como otro tipo de anestesia los siguientes documentos: 1. Consentimiento informado. 2. Ayuno, según edad. 3. Acceso venoso disponible. 4. Monitorización adecuada según procedimiento. Objective: To review the sedations that are performed in pediatric care outside the surgical area. This is always a challenge for the anesthesiologist, but particularly when the patients are children. We believe that the keys are: a protocol that establishes the drugs to be used and their routes of administration, monitoring, appointment of a nurse for the support of the anesthesiologist and, of course, a very good selection of the procedures. In fact, despite the many studies that have been published about sedation, many of these fail because the indications are not appropriate or because the person that performs them is not an anesthesiologist. Ou
Pediatric procedural sedation and analgesia
Meredith James,O′Keefe Kelly,Galwankar Sagar
Journal of Emergencies, Trauma and Shock , 2008,
Abstract: Procedural sedation and analgesia (PSA) is an evolving field in pediatric emergency medicine. As new drugs breach the boundaries of anesthesia in the Pediatric Emergency Department, parents, patients, and physicians are finding new and more satisfactory methods of sedation. Short acting, rapid onset agents with little or no lingering effects and improved safety profiles are replacing archaic regimens. This article discusses the warning signs and areas of a patient′s medical history that are particularly pertinent to procedural sedation and the drugs used. The necessary equipment is detailed to provide the groundwork for implementing safe sedation in children. It is important for practitioners to familiarize themselves with a select few of the PSA drugs, rather than the entire list of sedatives. Those agents most relevant to PSA in the pediatric emergency department are presented.
Strategies to optimize analgesia and sedation
William D Schweickert, John P Kress
Critical Care , 2008, DOI: 10.1186/cc6151
Abstract: Ensuring patient comfort and safety is a universal goal for critical care practitioners. Patients undergoing mechanical ventilation experience significant stress superimposed on their acute medical problem, ranging from anxiety about their surroundings and condition to distress with potential pain from necessary nursing care and procedures. Non-pharmacologic therapies such as comfortable positioning in bed and verbal reassurance are reasonable initial considerations, but a need for sedatives and analgesics to promote tolerance to the intensive care unit (ICU) environment is typically the rule.Sedation needs vary widely in mechanically ventilated patients. ICU patients frequently exhibit unpredictable pharmacology with accumulation of drug in tissue stores, resulting in a prolonged clinical effect. Other variables that confound attempts to predict drug effect include renal and hepatic dysfunction, drug-drug interactions, hypoproteinemia, and shock. As a result, sedatives and analgesics must be titrated to discernible and reproducible clinical end-points. Because the drugs used in this context are extremely potent, clinicians must have heightened awareness of the potential for enduring effects and are encouraged to employ strategies that maximize benefit while minimizing risk.The risk for untreated pain or agitation is a primary concern. Most mechanically ventilated patients experience some degree of pain even in the absence of surgical incisions or trauma [1,2]. Accordingly, it is critical for clinicians to direct initial attention toward analgesia when they administer 'sedation'. Untreated pain may cause many adverse effects, including increased endogenous catecholamine activity, myocardial ischemia, hypercoagulability, hypermetabolic states, sleep deprivation, anxiety, and delirium [3]; treating this pain has been shown to ameliorate some of these effects [4]. Untreated agitation, particularly in the delirious patient, may result in similar problems, including pati
Study on Sedation with Local Analgesia in Calves  [cached]
NC Sarker,MA Hashim,BP Ray,SK Sarker
Journal of Animal Production , 2011,
Abstract: The effect of sedatives and analgesics on heart rate, respiration rate and rectal temperature were observed. Heart rate and respiration rate significantly decreased during sedation with xylazine hydrochloride plus 2% lignocaine hydrochloride or 0.5% bupivacaine hydrochloride. A significantly decreased heart rate and respiration rate also found during sedation with diazepam plus 2% lignocaine hydrochloride or 0.5% bupivacaine hydrochloride. Two percent lignocaine hydrochloride showed short onset, rapid spreading and no side effect. Duration of analgesia was longer with 0.5 % bupivacaine hydrochloride (55.88±1.58 min in Group B and 48±11.25 min in Group D) compared to 2% lignocaine hydrochloride (39.60±5.77 min in Group A and 43.6±5.81 min in Group C). Xylazine hydrochloride showed short onset and long duration of sedation compared to diazepam. So for herniorraphy, xylazine hydrochloride can be used as a better sedative while 0.5 % bupivacaine hydrochloride can be used as a local analgesic for longer duration of action.Key Words: lignocaine hydrochloride, sedation, analgesia
Sedation and analgesia in gastrointestinal endoscopy: What’s new?  [cached]
Lorella Fanti, Pier Alberto Testoni
World Journal of Gastroenterology , 2010,
Abstract: Various types of sedation and analgesia technique have been used during gastrointestinal endoscopy procedures. The best methods for analgesia and sedation during gastrointestinal endoscopy are still debated. Providing an adequate regimen of sedation/analgesia might be considered an art, influencing several aspects of endoscopic procedures: the quality of the examination, the patient’s cooperation and the patient’s and physician’s satisfaction with the sedation. The properties of a model sedative agent for endoscopy would include rapid onset and offset of action, analgesic and anxiolytic effects, ease of titration to desired level of sedation, rapid recovery and an excellent safety profile. Therefore there is an impulse for development of new approaches to endoscopic sedation. This article provides an update on the methods of sedation today available and future directions in endoscopic sedation.
Sedation and analgesia in pediatric intensive care unit  [cached]
Khilnani P,Kaur J
Indian Journal of Critical Care Medicine , 2003,
Abstract: Common indications of sedation in the PICU (Pediatric intensive care unit) include mechanical Ventilation and various procedures performed in the PICU and in radiology or endoscopy suites. Sedation potentiates the effect of narcotics, thereby ensuring better comfort and analgesia. Sedation is a mandatory prerequisite prior to and during administration of neuromuscular blockers. This review includes practical pharmacology and uses of commonly used agents in the PICU.
Sedation and Analgesia in Children with Developmental Disabilities and Neurologic Disorders  [PDF]
Todd J. Kilbaugh,Stuart H. Friess,Ramesh Raghupathi,Jimmy W. Huh
International Journal of Pediatrics , 2010, DOI: 10.1155/2010/189142
Abstract: Sedation and analgesia performed by the pediatrician and pediatric subspecialists are becoming increasingly common for diagnostic and therapeutic purposes in children with developmental disabilities and neurologic disorders (autism, epilepsy, stroke, obstructive hydrocephalus, traumatic brain injury, intracranial hemorrhage, and hypoxic-ischemic encephalopathy). The overall objectives of this paper are (1) to provide an overview on recent studies that highlight the increased risk for respiratory complications following sedation and analgesia in children with developmental disabilities and neurologic disorders, (2) to provide a better understanding of sedatives and analgesic medications which are commonly used in children with developmental disabilities and neurologic disorders on the central nervous system.
Medications for analgesia and sedation in the intensive care unit: an overview
Diederik Gommers, Jan Bakker
Critical Care , 2008, DOI: 10.1186/cc6150
Abstract: Critically ill patients are often uncomfortable because of pain, anxiety, and reluctance to undergo mechanical ventilation. This discomfort is treated with continuous sedation, usually in combination with an opioid at low dose. However, continuous sedation has been associated with prolonged mechanical ventilation and a longer stay in the intensive care unit (ICU), whereas daily interruption of sedative treatment has been shown to reduce the duration of mechanical ventilation and ICU stay [1]. Therefore, a shift from deep to light sedation is currently recommended. In addition, recent studies suggest that analgesia-based sedation protocols are as effective as conventional hypnotic-based sedation protocols but that the required dose of hypnotic drug is reduced [2,3].Thus, meeting the goals of analgesia and sedation in the ICU may require a change in both protocols and drugs used. In this review we discuss the most commonly used drugs in the ICU, focusing on the short-acting agents.Analgesia should be titrated to the needs of the individual patient. This individual treatment plan usually consists of a basal regimen that is adapted to the patient's pain perception and general features (age, body mass, and so on), in combination with a rescue dose for incidental and procedural pain. Analgesics can be administered by enteral, transcutaneous and parenteral routes. However, delayed gastric emptying, (continuous) gastric drainage, decreased gut function, uncertain first-pass effect, general edema, and use of vasopressors, usually make the parenteral route preferable in critically ill patients. Parenteral drugs can be given by continuous infusion, bolus and patient-controlled analgesic techniques. In addition, epidural infusions of local anesthetics, often combined with opioids, can provide effective analgesia, for example in the case of fractured ribs or thoracic or abdominal wounds.Epidural analgesia is used extensively in modern anesthetic practice. A meta-analysis of more
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