ABSTRACT
El trauma es uno de los principales retos en cuanto a salud pública mundial se trata. Según la OMS, causa alrededor de cinco millones de muertes al año, siendo el trauma de tórax uno de los más frecuentes, reportándose hasta 90-96% de lesiones penetrantes con una mortalidad cercana al 30%. La toracotomía es un procedimiento frecuentemente realizado en el servicio de urgencias, pero es una técnica dolorosa e incómoda que puede generar dificultades a la hora de su realización. Se requiere encontrar la información disponible acerca de la seguridad en la intervención bajo sedación y determinar su utilidad en el servicio de urgencias, así como conocer los niveles de sedación para poder realizar las diferentes técnicas y evaluar según el procedimiento a realizar a qué nivel se debe llevar el paciente. La utilización de fármacos para analgesia y sedación en este servicio tiene por objetivo el control efectivo y seguro del dolor, control de la ansiedad, para evitar movimientos del paciente, buscando disminuir las posibles complicaciones. En esta revisión se estudian medicamentos como ketamina, propofol, morfina, hidromorfona, fentanilo, etomidato y midazolam, así como sus posibles combinaciones para implementarlos en el proceso de sedación en la toracostomía de urgencia. No hay una estrategia terapéutica aplicable a todos los pacientes por lo que cada una de ellas debe individualizarse..Au
Trauma constitutes one of the main challenges in terms of public health in the world. According to the WHO, it causes about five million deaths per year, chest trauma is one of the most frequently occurring injuries, reporting up to 90-96% of penetrating injuries with mortality close to 30%. Thoracostomy is a procedure frequently performed in the emergency department, however, it is a painful and uncomfortable procedure, and there could be difficulties while it is done. It is required to find the available information about how safe a thoracostomy is under sedation is and determine its usefulness in the emergency department; learning the levels of sedation, and depending of the procedure the patient needs, determine the level of sedation the patient has to induced into. The use of medications for analgesia and sedation in the emergency room is aimed to the effective and safe control of pain and anxiety as well as to avoid movements of the patient to reduce complications. This review considers medications such as ketamine, propofol, morphine, hydromorphone, fentanyl, etomidate, midazolam and the best combinations of these medications to carry out sedation for emergency thoracostomy. However, there is not a therapeutic strategy applicable to all patients, therefore each patient has to be analyzed individually..Au
Subject(s)
Humans , Thoracostomy , Emergency Service, HospitalABSTRACT
Modelo: Pesquisa clínica, aleatorizada, prospectiva e duplo-encoberta. Objetivo: Essa pesquisa objetivou comparar a eficácia do bloqueio interpleural e da anestesia peridural, associados à anestesia geral, no controle da dor pós - operatória de cirurgias de abdome superior. Metodologia: Participaram da pesquisa 80 pacientes alocados em 8 grupos(G) (n=10), de ambos os gêneros, idade variando de 18 a 50 anos, peso entre 50 e 100 kg, estado físico ASA P1 e P2, submetidos à colecistectomia por via subcostal, sob bloqueios interpleural(I) ou peridural(P) associados à anestesia geral. Foram administradas: levobupivacaína (L) 0,5% (100 mg) com adrenalina (5 μg.mL-1) ou ropivacaína (R) 0,75% (150 mg), morfina (M) (3 mg) e clonidina (C) (3 μg.kg-1) ou dextrocetamina (K) (0,5 mg.kg-1), por via interpleural, ao nível EIC7, na linha axilar média, com agulha de Tuohy 17G; os mesmos fármacos foram injetados, por via peridural, ao nível T12-L1, com agulha de Tuohy 17G. A indução da anestesia geral foi realizada com a administração de etomidato (0,2 mg.kg-1), alfentanil (30 μg.kg-1) e rocurônio (0,6 mg.kg-1) e a manutenção com oxigênio e isoflurano (0,5vol% a 3,0vol%). A analgesia pós-operatória, analisada pela Escala Verbal Analógica de Dor, foi observada às 6h, 12h, 18h e 24h após o término do ato operatório...
Results: Until six hours after surgery, 14 patients undergoing interpleural block and 7 undergoing epidural anesthesia felt pain. From six to twelve hours, 32 patients undergoing interpleural block and 14 undergoing epidural anesthesia presented pain. Between twelve and eighteen hours, 34 patients undergoing interpleural block and 21 undergoing epidural anesthesia felt pain. From eighteen to twenty-four hours, 36 patients undergoing interpleural block and 25 undergoing epidural anesthesia presented pain. A statistically significant difference was observed comparing the techniques at the period between 6 -12h, 12-18h and 18-24h. Eight patients undergoing interpleural block and three undergoing epidural anesthesia required opioid...