PROCEDIMIENTOS MENORES: ANALGESIA Y SEDACIÓN. Susana Capapé Urgencias Pediatría . Hospital Cruces Febrero 2007. Krauss B. Green SM. Sedation and analgesia for procedures in children. New England Journal of Medicine . 342(13):938-45, 2000 Mar 30. ANESTESICOS TÓPICOS / LOCALES.
Urgencias Pediatría. Hospital Cruces
Krauss B. Green SM. Sedation and analgesia for procedures in children. NewEnglandJournal of Medicine. 342(13):938-45, 2000 Mar 30.
LIDOCAÍNA (0,5%- 2%)
Con adrenalina 2-4 mgr/kg (máx 7 mgr/kg)
Con adrenalina 60- 180 min
Oral midazolam for conscious sedation of children during minor procedures.Journal of Accident & Emergency Medicine. 15(4):244-8, 1998 Jul.0,5 mg/ kg oral midazolam had an onset of action of 15 minutes and was effective in 76% of children Amnesia was reported in 66% of children. There were no adverse side effects except paradoxical hyperagitation in three ; this did not require any specific treatment. 90% of parents said they would like it to be used again should similar circumstances arise.
At 0.5 mg/kg oral midazolam appears safe and is effective in sedating most children for minor procedures. Its use should be considered by all A&E departments dealing with children.
la ansiedad del paciente y para conseguir un paciente colaborador:
En los casos en los que el procedimiento sea doloroso se asociarananalgésicos tópicos/locales o sistémicos.
Midazolam syrup as a premedication to reduce the discomfort associated with pediatric intravenous catheter insertion. J Pediatr 2003;142:429-30)
.Midazolam effectively reduces discomfort associated with intravenous insertion.
Anxiolysis with oral midazolam in pediatric patients undergoing dermatologic surgical procedures.Journal of the American Academy of Dermatology. 45(1):105-8, 2001 Jul.Oral midazolam provided good to excellent anxiolytic effects in most pediatric patients undergoing painful dermatologic surgical procedures. Because midazolam does not provide analgesic effects, local anesthesia is necessary. Complications were uncommon and minor. Oral midazolam is an effective anxiolytic agent in pediatric patients undergoing dermatologic surgical procedures.
Clinical policy : procedural sedation anda analgesia in the emergency department . From The American College of Emergency Physicians .Clinical Policies Subcommitte on procedural sedation and analgesia.
Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: Addendum . AAP.Committee on Drugs. PEDIATRICS 2002; 110 (4)836-838.
Gross JB, et al: Practice guidelines for sedation and analgesia by non-anesthesiologist. ASA. Gross JB, et al: Anesthesiology 2002; 96:100-1017
En los casos en los que el procedimiento sea doloroso se asociaran analgésicos tópicos/locales o sistémicos.
A total of 819 patients were included in this study. Both the N2O and midazolam groups demonstrated a low complication rate with a high rate of successful completion of treatment. The use of either oral midazolam or nitrous oxide-oxygen as single agents provides safe and effective conscious sedation in the pediatric outpatient population.
Sedation during voiding cystourethrography: comparison of the efficacy and safety of using oral midazolam and continuous flow nitrous oxide.Journal of Urology. 174(4 Pt 2):1598-600; 2005 Oct.
Continuous flow 50% nitrous oxide and oral midazolam are comparably safe and effective in reducing anxiety and distress during VCU in children older than 3 years. However, N(2)O provides a more rapid onset of sedating effect and has a shorter recovery time: shorter recovery time (29 +/- 10 vs 63 +/- 25 minutes, p <0.001)..
Breathing patterns and levels of consciousness in children during administration of nitrous oxide after oral midazolam premedication.Journal of Oral & Maxillofacial Surgery. 55(12):1372-7; 1997 Dec.
The addition of 40% N2O to oral midazolam, 0.7 mg/kg, did not result in clinically meaningful respiratory depression nor upper airway obstruction, but did, in some children, cause an increase in the level of sedation beyond simple conscious
MIDAZOLAM ORAL Y OXIDO NITROSO
Nivel 0 : Ausencia de sedación ; Nivel 1 - 3 : Sedación consciente ; Nivel 4 -6 : Sedación profunda