Analgesia e sedação em situações de emergência e unidades de tratamento intensivo pediátrico

Abstract

Objective: To review the current strategies for use of sedatives and analgesics in emergency rooms and intensive care units. Sources of data:Original data from our emergency rooms and intensive care units; Medline literature review focused on sedatives and analgesic drugs; textbooks. Summary of the findings:Despite the advances in understanding pain in children, in many critical care units the misguided treatment of pain and anxiety still results in significant morbidity. Difficulties in communication, invasive procedures and the belief that children do not have sufficient neurologic development to process noxious sensations are still a challenge in intensive care units. Conclusions:The last decade was marked by significant advances in understanding pediatric pain. Treating intensive care unit-related pain and anxiety has clear benefits which may influence the course of disease.

Avaliação do procedimento de intubação traqueal em unidades de referência de terapia intensiva pediátricas e neonatais

“…15,[23][24][25] Set against this there appears to be a certain reluctance to use drugs because of the pharmacokinetic and metabolic alterations that commonly occur after the third trimester of pregnancy and last until at least 6 months of age, making the definition of dosages and the safety of drugs less predictable. 26,27 A systematic review of nine neonatology studies concluded that while there is not sufficient evidence to prove the safety of the use of pre-intubation drugs with newborns, their use should be considered. 11 The wide variation in drugs chosen and doses given reflects the lack of training in airway management both on medical undergraduate courses and at the start of postgraduation.…”

Assessment of intubation procedures at reference pediatric and neonatal intensive care units

“…Além disso, os efeitos benéficos da sedação e analgesia sobre a pressão intracraniana, risco de dano à via aérea, redução do tempo do procedimento de intubação e conforto do paciente deveriam ser considerados 15,[23][24][25] . Por outro lado, parece existir certo receio ao uso de drogas devido às alterações farmacocinéticas e de metabolismo que costumam ocorrer a partir do terceiro trimestre de gestação e persistir pelo menos até os 6 meses de vida, tornando a definição das doses e a segurança dos fármacos mais imprevisíveis 26,27 . Revisão sistemática realizada com nove estudos em neonatologia concluiu que, apesar de não existirem dados suficientes para estabelecer a segurança do uso de medicações pré-intubação em neonatos, deve-se considerar seu uso 11 .…”

Fatores relacionados ao uso de analgesia sistêmica em neonatologia

“…(16,(34)(35)(36)(37)(38) The following drugs are more frequently used in neonatal intensive care units. (9,39) Non-opioid analgesics Among the drugs in this group only paracetamol is released for use in the neonatal period, however, in Brazil, it is not produced for parenteral use, restricting utilization in neonatal intensive care units. (16,40) The recommended dose is 10 to 15 mg/kg for full-term newborn and 10 mg/kg for premature, every six hours.…”