COMPLICATIILE SEDARII PACIENTULUI DE VARSTA PEDIATRICA IN TIMPUL PROCEDURILOR DIAGNOSTICE SI TERAPEUTICE

Universitatea “Lucian Blaga”

Facultatea de Medicina “Victor Papilian”

COMPLICATIILE SEDARII PACIENTULUI DE VARSTA PEDIATRICA IN TIMPUL PROCEDURILOR DIAGNOSTICE SI TERAPEUTICE

CUPRINS

I.    Introducere. Motivatia alegerii temei.

Modalitatile de evaluare a durerii acute sunt in primul rand calitative si mai putin cantitative, datorita componentei subiective a durerii si a importantelor influente psiho-emotionale, educational-culturale, etc., care isi pun amprenta asupra unora dintre caracteristicile acesteia.

Scala celor sase fete cuantifica intesitatea durerii functie de mimica (16).

Modalitati de tratament al durerii la copil/medictie folosita pentru sedare si analgezie la copil

Substante farmacolgice

Sedarea la copil

Nivelul de sedare poate fi cuantificat dupa scorul Ramsay de evaluare a sedarii: 1- pacient anxios si agitat /nelinistit, sau ambele; 2 - pacientul coopereaza, este orientat si linistit; 3 - pacientul raspunde numai la comenzi; 4 - pacientul prezinta un raspuns promt la stimuli mecanici si auditivi puternici; 5 - pacientul prezinta un raspuns slab la stimuli mecanici si auditivi puternici; 6 - pacientul nu prezinta nici un raspuns.

Varsta, luni

Solide, lichide neclare (ore)

Lichide clare (ore)

<6

>36

American Society of Anesthesiologists. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures. A Report of the American Society of Anesthesiologists. Available at: “www.asahq.org/publicationsAndServices/npoguide.html”.

Daca interventia are loc in conditii de urgenta, clasificarea este urmata de litera E (emergency).

Fig. 1. Pozitionarea corecta a mastii pe fata

Partea speciala

Fisa consult preanestezic

Nume Prenume Varsta

Sex Greutate grup sanguin

Diagnostic:

Interventia propusa:

Fisa consult preanestezic

Intubatie

Mobilitate cervicala

Macroglosie

Tonsile

Dentitie

Mallampati

Medicatie preoperator

ASA

Medic

In fisa de monitorizare a sedarii am notat date despre statusul pre-anestezic, apoi date legate de functiile vitale, la fiecare 5 minute.

Fisa de monitorizare sedare/ anestezie

Data

Nume: Prenume: Alergii:

Varsta: Sex: Greutate: Grup sgv.:

Diagnostic:   

Interventia propusa:

Sedare/ monitorizare Saltea termica

Abord venos Pozitie

Abord arterial

Sonda gastrica

Sonda urinara

Confort medic curant:

Legenda:

Tip respiratie: spontana

controlata

TA

AV

Comentarii:

Medic,

Dupa terminarea procedurii, am continuat monitorizarea pacientilor, pana la indeplinirea criteriilor de externare. Si aceste date au fost notate in formulare special concepute:

Fisa monitorizare postsedare

Data

Nume: Prenume: Alergii:

Varsta: Sex: Greutate: Grup sgv.:

Diagnostic:   

Interventia propusa:

Legenda:

Tip respiratie: spontana

controlata

TA

AV

Comentarii:

Medic

Protocol terapeutic

Fisa consult preanestezic

Intubatie

Mobilitate cervicala

Macroglosie

Tonsile

Dentitie

Mallampati

Medicatie preoperator

ASA

Medic

Fisa de monitorizare sedare/ anestezie

Data

Nume: Prenume: Alergii:

Varsta: Sex: Greutate: Grup sgv.:

Diagnostic:   

Interventia propusa:

Sedare/ monitorizare Saltea termica

Abord venos Pozitie

Abord arterial

Sonda gastrica

Sonda urinara

Confort medic curant:

Legenda:

Tip respiratie: spontana

controlata

TA

AV

Comentarii:

Medic,

Fisa monitorizare postsedare

Data

Nume: Prenume: Alergii:

Varsta: Sex: Greutate: Grup sgv.:

Diagnostic:   

Interventia propusa:

Legenda:

Tip respiratie: spontana

controlata

TA

AV

Comentarii:

Medic

Bibliografie:

Safe sedation of children undergoing diagnostic and therapeutic procedures, Guideline No. 58, Revised Edition: April 2004 [Online]. Available from URL: https://www.sign.ac.uk

European Journal of Anaesthesiology 2007, 24(07):563-567

Ghiduri de sedare si/sau analgezie pentru medicii din alte specialitati decat anestezie-terapie intensiva. Jurnalul Roman de Terapie Intensiva 2007, vol.14, nr.2: 129-133

Daniel J. Pallin. Procedural Sedation Is Safe for Children Younger Than 2 Years. [Online]. Available from URL https://www.medscape.com/viewarticle/584654

CHN Guidelines – Management of Children Receiving Conscious or Deep Sedation. June 2002. [ONLINE]. Available from URL https://www.childhealthnetwork.com

Steinbacher D. Propofol: A Sedative-Hypnotic Anesthetic Agent for Use in Ambulatory Procedures. [ONLINE]. Available from URL https://www.ncbi.nlm.nih.gov/

Reeves S., Havidich J., Tobin P. Conscious Sedation of Children With Propofol Is Anything but Conscious [ONLINE]. Available from URL https://pediatrics.aappublications.org/

M C Howes. Ketamine for paediatric sedation/analgesia in the emergency department. Emergency Medicine Journal 2004;21:275-280; doi:10.1136/emj.2003.005769

Handan A., Zerrin G., Cahit K. Efficacy and safety of rectal thiopental: Sedation for children undergoing computed tomography and magnetic resonance imaging. Pediatrics International, Volume 41, Number 5, October 1999 , pp. 538-541(4)

Davies F.C., Waters M. Oral midazolam for conscious sedation of children during minor procedures. J Accid Emerg Med. 1998 July;

Disma N, Astuto M, Rizzo G, Rosano G, Naso P, Aprile G, Bonanno G, Russo A. Propofol sedation with fentanyl or midazolam during oesophagogastroduodenoscopy in children. Eur J Anaesthesiol. 2005 Nov;22(11):848-52.