Resumo

LOPEZ, J. M. et al. Safety and effectiveness of the sedoanalgesia with fentanyl and propofol: Experience in a pediatric intensive medicine unit. Med. Intensiva [online]. 2007, vol.31, n.8, pp.417-422. ISSN 0210-5691.

Objective. Apply a sedoanalgesic (SA) protocol for invasive procedures (PI) in pediatric patients and evaluate its effectiveness and safety. Design. Prospective observational study. Scope. Pediatric Intensive Care Unit (PICU) of third level hospital. Patients. A total of 110 children subjected to invasive procedures under sedoanalgesia with propofol and fentanyl. Intervention. Sedoanalgesic protocol for invasive procedure was applied with: fentanyl (1-2 mcg/kg with maximum dose of 100 mcg for first dose and 50 mcg for the next) and propofol (1-2 mg/kg with maximum of 100 mg for first dose and 50 mg for the next). The objective was to reach III-IV sedoanalgesic grade for modified Ramsay scale and amnesia related to invasive procedure. Main endpoints. a) time to sedoanalgesia and recovery, length for invasive procedure and stay in the Pediatric Intensive Care Unit; b) mean dose of drug; c) sedoanalgesic grade and amnesia related to invasive procedure and d) adverse events. Results. Five hundreds SA were made for 634 IP in 110 children. The most common conditions were oncohematologics (91%), the spinal tap for intrathecal treatment was the most frequent IP (48.5%). Most of the patients (96.8%) did not recall the procedure and an optimum SA was obtained in 93.4%. Patients profoundly sedated presented a significant fall of systolic arterial pressure (88 ± 19 vs 98 ± 14 mmHg, p < 0.001) compared to those with minor SA level, as well as heart rate (88 ± 17 vs 91 ± 25 bpm, p < 0.05) and respiratory rate (19 ± 6 vs 23 ± 11 bpm, p < 0.05). Mean time to reach adequate sedation was 4.62 ± 3.69 minutes and stay time in PICU 41.8 ± 19. Complication incidence was 6.6% (apnea, hypotension, bradycardia), these were resolved with manual ventilation and/or volume expansion. Conclusions. SA protocol reached its goal of: a) effectiveness: SA achieved was optimal, with amnesia of the procedure in almost all patients and b) safety: complications were controlled due to monitorization and stabilization measurements.

Palavras-chave : sedoanalgesic; pediatric; propofol; fentanyl; effectiveness; safety; invasive procedures.