[Safety and effectiveness of the sedoanalgesia with fentanyl and propofol. Experience in a pediatric intensive medicine unit]

J M López, M Valerón, O Pérez, E Consuegra, L Urquía, A Morón, R González
Medicina Intensiva 2007, 31 (8): 417-22

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.

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