Resultados tras implantación de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario / Results after implementation of a sedoanalgesia protocol for procedures in hospital environment

INTRODUCCIÓN: Se analiza la efectividad y seguridad de un protocolo específico de sedoanalgesia para procedimien tos, y evalúa la satisfacción del personal sanitario con cada procedimiento. PACIENTES Y MÉTODO: Estudio prospectivo de un protocolo de sedoanalgesia para procedimientos en ámbito hospitalario en menores de 18 años, con una estrategia individualizada según la situación basal del paciente, el tipo de procedimiento y la experiencia del pediatra responsable de la sedación. Se registraron las variables: diagnóstico que motiva el procedimiento, tipo de procedimiento, datos antropométri cos, alergias, medicación, estado ASA y enfermedad de base, tiempo de ayuno, auscultación pul monar, temperatura, saturación de oxígeno, frecuencia respiratoria, frecuencia cardiaca, tensión arterial, lugar de sedación, tipo de fármaco, dosis, tipo de vía, escala de sedación Ramsay, duración de la sedación, tipo y tratamiento de efectos adversos, presencia de familiares durante todo el pro cedimiento y satisfacción del paciente. RESULTADOS: Se realizaron 279 sedaciones. Los fármacos más usados fueron óxido nitroso (62,7%) y midazolam (16,5%); las vías de administración más utili zadas fueron la inhalada (62,4%) y la intravenosa (15,8%). La satisfacción fue alta para el pediatra (92,5%), el enfermero (94,3%), los familiares (96,8%) y los pacientes (93,6%), con una buena correlación entre ellos, y fue significativamente menor al usar midazolam y las vías nasal y bucal. La tasa de efectos adversos fue del 3,2%, y ninguno fue grave. CONCLUSIONES: La implementación de un protocolo específico de sedoanalgesia para procedimientos en el ámbito hospitalario consigue una alta efectividad y seguridad, además de un alto nivel de satisfacción, tanto en familiares como en personal sanitario.

INTRODUCTION: We analyze the effectiveness and safety of a specific analgosedation protocol for procedures, and eva luate the satisfaction of the health personnel with each procedure. PATIENTS AND METHOD: Prospective study of an analgosedation protocol for hospital procedures in children under 18 years of age, with an individualized strategy based on the patient's baseline situation, the type of procedure and the experience of the pediatrician responsible for the sedation. The following variables were recorded: diagnosis motivating the procedure, type of procedure, anthropometric data, allergies, medication, ASA status and baseline disease, fasting time, lung auscultation, temperature, oxygen saturation, res piratory rate, heart rate, blood pressure, sedation location, type of drug, dose, route of administra tion, Ramsay sedation scale, duration of sedation, type and treatment of adverse effects, presence of family members throughout the procedure, and patient satisfaction. RESULTS: 279 sedations were performed. The most commonly used drugs were nitrous oxide (62.7%) and midazolam (16.5%); the most commonly used routes of administration were the inhaled one (62.4%) and the intravenous one (15.8%). The satisfaction was high for the pediatrician (92.5%), the nurse (94.3%), the family (96.8%), and patients (93.6%), with a good correlation between them, and it was significantly lower when using midazolam and the nasal and oral routes. The adverse effects rate was 3.2%, and none was severe. CONCLUSIONS: The implementation of a specific analgosedation protocol for procedures in the hospital environment achieves high levels of effectiveness and safety, as well as a high level of satisfaction, both in family members and in health personnel.

Efectividad de un protocolo para la atención del dolor en neonatos menores de 1 500 gramos / Effectiveness of a protocol for pain management in newborns with less than 1 500 grams

Introducción: La atención al dolor resulta prioritaria en las unidades de cuidados intensivos neonatales. No se recogen antecedentes en Cuba de implementación de algún protocolo para el abordaje del dolor en neonatos, que no se limite solamente al tratamiento farmacológico durante la asistencia respiratoria o cirugía neonatal. Objetivo: Determinar la efectividad de un protocolo para la prevención y alivio del dolor en recién nacidos menor de 500 gramos, basado principalmente en las recomendaciones de la Sociedad Iberoamericana de Neonatología. Métodos: Estudio basado en las recomendaciones de la Sociedad Iberoamericana de Neonatología, de tipo analítico prospectivo de ANTES y DESPUÉS en 55 neonatos menor de 1500 gramos, nacidos en el Hospital Ginecoobstétrico Docente Provincial de Matanzas en el período marzo/2016 a marzo/2018, en el cual se comparó la intensidad del dolor según la escala COMFORTneo aplicada durante la realización de tres procederes: inserción del catéter venoso umbilical, inserción de catéter percutáneo y punción del talón, en dos grupos de pacientes: un grupo antes (n=29) y un grupo después de aplicar el protocolo de dolor (n=26). Para el análisis de variables se empleó el coeficiente de Spearman. Se consideró significativo todo valor p menor de 0,05. Resultados: El peso promedio de los neonatos estudiados fue 1 180 gramos. Luego de la implementación del protocolo se observó una disminución significativa en la intensidad del dolor durante la realización de los procederes seleccionados. Las medidas no farmacológicas fueron las más empleadas. Conclusiones: El protocolo implementado es efectivo para lograr disminuir la intensidad del dolor en neonatos menor de 1 500 gramos(AU)

Introduction: Pain management is a priority in Neonatal Intensive Care Units. There are not antecedents in Cuba of any protocol carried out for management of neonatal pain, apart from the pharmacological treatment during neonatal respiratory assistance or surgery. Objective: To determine effectiveness of a protocol for prevention and pain relief in infants with less than 1500 grams, mainly based on recommendations of the Ibero-American Society of Neonatology. Methods: A prospective analytical study of before and after was made in 55 infants with less than 1500 grams, who were born in the Teaching Gynecological and Obstetric Provincial Hospital of Matanzas, Cuba, in the period from March,2016 to March, 2018. For the study, the intensity of pain was compared by means of the COMFORTneo scale, which was carried out during the performance of three procedures: umbilical vein catheterization, percutaneous venous catheterization and heel lance; in two patients groups: one before (n=29) and the other after the implementation of the pain protocol (n=26). Spearman coefficient was used for statistical analysis of ordinal qualitative variables. All less than; 0.05 values were considered significant. Results: The average weight of the studied newborns was 1 180 grams. After implementing the protocol, a significant decrease in pain intensity was observed during the performance of the selected procedures. Non-pharmacological measures were the most used. Conclusion: The implemented protocol is effective for decrease pain intensity in newborns with less than 1 500 grams(AU)

Comparison of topical and retrobulbar anesthesia in terms of pain experience during silicone oil extraction / Comparação da sensação de dor durante a extração de óleo de silicone sob anestesia tópica e retrobulbar

ABSTRACT Purpose: To compare the use of topical anesthesia and retrobulbar anesthesia during silicone oil removal with a mixed pars plana technique, through evaluating the pain experience of patients. Methods: We selected patients according to their behavior during previous vitreoretinal surgery and ophthalmologic examinations and divided them into two anesthesia groups: topical (n=36) and retrobulbar (n=33). We used a mixed technique for the passive removal of silicone oil in both groups. During each step of the surgery, the patients' pain experience and the surgeon's comfort were scored according to a pain scale. Results: The pain experienced during the application of the anesthesia was significantly greater in the retrobulbar group (p<0.001). The topical group experienced greater pain during trocar insertion (p<0.001). There was no significant difference between the groups regarding the overall pain experience or complications. Conclusions: The pain experience of the selected patients during silicone oil removal was comparable between the topical and the retrobulbar anesthesia. Topical anesthesia with the mixed pars plana technique is an effective and safe alternative option for silicone oil removal surgery.

RESUMO Objetivo: Comparar a sensação de dor de pacientes durante a remoção do óleo de silicone sob anestesia tópica e retrobulbar, usando uma técnica via pars plana combinada. Métodos: Os pacientes foram selecionados, de acordo com suas atitudes durante cirurgia vitreorretiniana prévia e exames oftalmológicos, e divididos em dois grupos: anestesia tópica e retrobulbar. Para a remoção passiva do óleo de silicone, utilizou-se uma técnica combinada em ambos os grupos. A sensação de dor dos pacientes e o conforto do cirurgião foram classificados através de uma escala de dor durante cada etapa da cirurgia. Resultados: Os grupos anestesia tópica e retrobulbar incluíram 36 e 33 pacientes, respectivamente. A sensação de dor durante a aplicação da anestesia foi significativamente maior no grupo retrobulbar (p<0,001). O grupo anestesia tópica sentiu mais dor durante a inserção do trocarte (p<0,001). Não houve diferença significativa entre os grupos em relação à sensação geral de dor e a complicações. Conclusões: A sensação de dor é comparável entre a anestesia tópica e a retrobulbar durante a remoção de óleo de silicone. A combinação de anestesia tópica e uma técnica via pars plana é uma opção alternativa eficaz e segura para a cirurgia de remoção de óleo de silicone.