Sedação e analgesia em crianças: uma abordagem prática para as situações mais freqüentes

Abstract

Objectives: To review the most frequent recommendations, doses and routes of administration of sedatives, analgesics, and muscle relaxants in children, as well as the methods for monitoring the level of sedation. Sources:Review of the literature using the MEDLINE database and review of the experience in pediatric intensive care units.

Clonidina associada à morfina e midazolam em crianças submetidas à ventilação mecânica: estudo aleatório, duplamente encoberto e placebo controlado

“…Na escala de sedação de Ramsay, esse estágio é representado por escore entre 2 e 3 20 . Existem evidências demonstrando que neste estudo as crianças submetidas à VM tenham sido excessivamente sedadas, tais como: as altas doses de morfina (doses diárias de aproximadamente 0,85 mg/kg/dia), de midazolam (doses diárias de 8 mg/kg/dia), e de sedativos intermitentes, assim como o seu prolongado tempo de uso (mediana 9 dias, tanto para morfina como midazolam), que é muito acima do recomendado na literatura 1,2,5,33 . Sabe-se que a utilização de fentanil em doses cumulativas de 1,6 a 2,5 mg/kg e por tempo acima de 5 a 9 dias, assim como o midazolam em doses superiores a 60 mg/kg, pelo mesmo período, estão relacionadas ao aparecimento de abstinência 3,9 .…”

“…É interessante ressaltar que a clonidina quando associada a baixas doses de sedativos analgésicos, pode prevenir ou reduzir o aparecimento de abstinência 4,9, 15,29 . Entretanto, neste estudo sugere-se que a clonidina perde essa ação preventiva quando utilizada em conjunto com altas doses de sedativos, pois a prevalência em ambos os grupos foi acima de 70%, muito superior ao descrito na literatura, em torno de 35% e 57% 1,9,15,29,33 . Portanto, parece que a clonidina para apresentar seus efeitos sedativos e protetores de abstinência, deve ser utilizada em associação com baixas doses de opióides e diazepínicos.…”

Comparison between Comfort-Behavior and Ramsay scales in a pediatric intensive care unit

“…A major objective of health professionals assisting children admitted to the PICU is to carry out treatments implying the less possible aggression to prevent further physical and emotional distress for children and their relatives 1,2 . This scenario of severe psychic impact added to the need for mechanical ventilation support, is among the most common indications for the use of analgesia and/or sedation for these patients.…”

“…This scenario of severe psychic impact added to the need for mechanical ventilation support, is among the most common indications for the use of analgesia and/or sedation for these patients. Analgesia and sedation, in addition to optimizing the treatment, provide comfort, control pain and decrease the level of anxiety and agitation of these patients 1,2 . Notwithstanding the benefits of vasoactive and analgesic drugs for critically ill patients, the excessive use is associated to increased hospitalization time, risk of infections and mortality rate, in addition to the probability of developing withdrawal symptoms when they are interrupted, which may vary in quality and intensity [1][2][3][4] .…”

“…Analgesia and sedation, in addition to optimizing the treatment, provide comfort, control pain and decrease the level of anxiety and agitation of these patients 1,2 . Notwithstanding the benefits of vasoactive and analgesic drugs for critically ill patients, the excessive use is associated to increased hospitalization time, risk of infections and mortality rate, in addition to the probability of developing withdrawal symptoms when they are interrupted, which may vary in quality and intensity [1][2][3][4] . The use of sedation/analgesia should be carefully evaluated by the medical team by means of reached sedation levels, to use the lowest possible dose and minimize the risk of adverse events, giving priority to optimal sedation.…”