Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942007000500013
Brazilian Journal of Anesthesiology
Review Article

Sedação e analgesia em neonatologia

Sedation and analgesia in neonatology

Yerkes Pereira e Silva; Renato Santiago Gomez; Thadeu Alves Máximo; Ana Cristina Simões e Silva

http://dx.doi.org/10.1590/S0034-70942007000500013 Braz J Anesthesiol, vol.57, n5, p.575-587, 2007
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Resumo

JUSTIFICATIVA E OBJETIVOS: A importância do estudo da dor em Neonatologia se deve ao fato de que a sensação de dor e estresse significa sofrimento e desconforto para os recém-nascidos e, apesar desse conhecimento, pouco tem sido feito para minimizá-los. Nessa revisão foram discutidas: a prevenção da dor, as medidas não-farmacológicas e farmacológicas para o seu tratamento e a sedação em recém-nascidos. CONTEÚDO: Várias são as medidas não-farmacológicas que podem ser tomadas com intuito de prevenir a dor nas Unidades de Terapia Intensiva Neonatal e também para tornar o ambiente mais humanizado e menos estressante para os pacientes e seus familiares. O tratamento da dor no recém-nascido consiste em medidas não-farmacológicas (sucção não-nutritiva, glicose) e farmacológicas (analgésicos não-opióides, opióides e anestésicos locais). A sedação em recém-nascidos é produzida por fármacos que agem diminuindo a atividade, a ansiedade e a agitação do paciente, podendo levar à amnésia de eventos dolorosos ou não-dolorosos. A sedação pode ser feita pela administração de hidrato de cloral, barbitúricos, propofol e benzodiazepínicos. CONCLUSÕES: A prevenção da dor e a indicação de analgesia devem ser individualizadas e sempre consideradas em todos os recém-nascidos portadores de doenças potencialmente dolorosas e/ou submetidos a procedimentos invasivos, cirúrgicos ou não.

Palavras-chave

ANALGÉSICOS, Opióides, ANALGÉSICOS, Não-opióides, ANESTÉSICOS, DOR, Tratamento, SEDAÇÃO

Abstract

BACKGROUND AND OBJECTIVES: The study of pain in neonatology is important because pain and stress mean suffering and discomfort for newborns and, despite it, very little has been done to minimize them. In this revision we discuss: prevention of pain, non-pharmacological and pharmacological treatment, and sedation in newborns. CONTENTS: Several non-pharmacological measures can be taken to prevent pain in Neonatal Intensive Care Units, and to humanize and reduce the stress on the environment for patients and their families. Pain treatment in the newborn consists of non-pharmacological (non-nutritive suckling, glucose) and pharmacological (non-opioid analgesics, opioids, and local anesthetics) measures. Sedation in the newborn is achieved with drugs that decrease activity, anxiety, and agitation of the patient, and that could lead to amnesia of painful and non-painful events. Sedation can be accomplished with chloral hydrate, barbiturates, propofol, and benzodiazepines. CONCLUSIONS: Prevention of pain and the indication of analgesia should be individualized and always considered in every newborn with potentially painful disorders and/or undergoing invasive procedures, surgical or not.

Keywords

ANALGESICS, Opioids, ANALGESICS, ANESTHETICS, PAIN, Treatment, SEDATION

References

Guinsburg R. Avaliação e tratamento da dor no recém-nascido. J Pediatr (RJ). 1999;75:149-160.

Franck LS, Lawhon G. Environmental and behavioral strategies to prevent and manage neonatal pain. Semin Perinat. 1998;22:434-443.

Anand KJ. Clinical importance of pain and stress in preterm neonates. Biol Neonate. 1998;73:1-9.

Chermont AG, Guinsburg R, Balda RCX. O que os pediatras conhecem sobre avaliação e tratamento da dor no recém-nascido?. J Pediatr (RJ). 2003;79:265-272.

Walco GA, Cassidy RC, Schechter NL. Pain, hurt and harm. The ethics of pain control in infants and children. N Engl J Med. 1994;293:918-919.

Bauchner H, May A, Coates E. Use of analgesic agents for invasive medical procedures in pediatric and neonatal intensive care units. J Pediatr. 1992;121:647-649.

Barker DP, Rutter N. Exposure to invasive procedures in neonatal intensive care admissions. Arch Dis Child. 1995;72:47-48.

Anand KJ. International Evidence-Based Group for Neonatal Pain Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001;155:173-180.

Menon G, Anand KJ, McIntosh N. Practical approach to analgesia and sedation in the neonatal intensive care unit. Semin Perinatol. 1998;22:417-424.

Machado MGP, Barbosa RFB, Silva YP. A dor em neonatologia. Dor em Pediatria. 2006:105-115.

Gray L, Miller LW, Philipp BL. Breastfeeding is analgesic in healthy newborns. Pediatrics. 2002;109:590-593.

Blass EM, Hoffemeyer LB. Sucrose as an analgesic for newborn infants. Pediatrics. 1991;87:215-218.

Rebouças EC, Segato EN, Kishi R. Effect of the blockade of mu1-opioid and 5HT2A-serotonergic/alpha1-noradrenergic receptors on sweet-substance-induced analgesia. Psychopharmacology. 2005;179:349-355.

Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2004;3:CD001069.

Stevens B, Yamada J, Beyene J. Consistent management of repeated procedural pain with sucrose in preterm neonates: is it effective and safe for repeated use over time?. Clin J Pain. 2005;21:543-548.

Aranda JV, Carlo W, Hummel P. Analgesia and sedation during mechanical ventilation in neonates. Clin Ther. 2005;27:877-899.

Lyn YC, Sussman HH, Benitz WE. Plasma concentrations after rectal administration of acetaminophen in preterm neonates. Paediatr Anaesth. 1997;7:457-459.

Taddio A. Opioid analgesia for infants in the neonatal intensive care unit. Clin Perinatol. 2002;29:493-509.

Bellu R, de Waal KA, Zanini R. Opioids for neonates receiving mechanical ventilation. Cochrane Database Syst Rev. 2005;1:CD004212.

Camu F, Vanlersberghe C. Pharmacology of systemic analgesics. Best Pract Res Clin Anaesthesiol. 2002;16:475-488.

Bhat R, Chari G, Gulati A. Pharmacokinetics of a single dose of morphine in preterm infants during the first week of life. J Pediatr. 1990;117:477-481.

Bhat R, Chari G, Iver R. Postconceptual age influences pharmacokinetics and metabolism of morphine in sick neonates. Pediatr Res. 1994;35:81A.

Stoelting RK, Hiller SC. Opioids agonists and antagonists. Pharmacology & Physiology in Anesthetic Practice. 2006:87-126.

Franck LS, Miaskowski C. The use of intravenous opioids to provide analgesia in critically ill, premature neonates: a research critique. J Pain Symptom Manage. 1998;15:41-69.

Chay PC, Duffy BJ, Walker JS. Pharmacokinetics-pharmacodynamic relationships of morphine in neonates. Clin Pharmacol Ther. 1992;51:334-342.

Fahnenstich H, Steffan J, Kau N. Fentanyl-induced chest wall rigidity and laryngospasm in preterm and term infants. Crit Care Med. 2000;28:836-839.

Meistelman C, Benhamou D, Barre J. Effects of age on plasma protein binding of sufentanil. Anesthesiology. 1990;72:470-473.

Glass PS. Remifentanil: a new opioid. J Clin Anesth. 1995;7:558-563.

Hoke JF, Shlugman D, Dershwitz M. Pharmacokinetics and pharmacodynamics of remifentanil in persons with renal failure compared with healthy volunteers. Anesthesiology. 1997;87:533-541.

Eck JB, Lynn AM. Use of remifentanil in infants. Paediatr Anaesth. 1998;8:437-439.

Ross AK, Davis PJ, Dear GD. Pharmacokinetics of remifentanil in anesthetized pediatric patients undergoing elective surgery or diagnostic procedures. Anesth Analg. 2001;93:1393-1401.

Sammartino M, Bocci MG, Ferro G. Efficacy and safety of continuous intravenous infusion of remifentanil in preterm infants undergoing laser therapy in retinopathy of prematurity: clinical experience. Paediatr Anaesth. 2003;13:596-602.

Silva YP, Gomez RS, Barbosa RF. Remifentanil for sedation and analgesia in a preterm neonate with respiratory distress syndrome. Paediatr Anaesth. 2005;15:993-996.

Anderson BJ, Palmer GM. Recent developments in the pharmacological management of pain in children. Curr Opin Anaesthesiol. ;19:2006.

Acharya AB, Bustani PC, Phillips JD. Randomised controlled trial of eutectic mixture of local anaesthetics cream for venepuncture in healthy preterm neonates. Arch Dis Child Fetal Neonatal Ed. 1998;78:F138-142.

Kleiber C, Sorenson M, Whiteside K. Topical anesthesics for intravenous insertion in children: a randomized equivalency study. Pediatrics. 2002;110:758-761.

Stoelting RK, Hiller SC. Barbiturates. Pharmacology & Physiology in Anesthetic Practice. 2006:127-139.

Wolf AR. Neonatal sedation: more art than Science. Lancet. 1994;344:628-629.

Ambuel B, Hamlett KW, Marx CM. Assessing distress in pediatric intensive care environments: the COMFORT scale. J Pediatric Psychol. 1992:17.

Charney DS, Mihic JS, Harris RA. Hypnotics and sedatives. Goodman and Gilman's the pharmacological basis of therapeutics. 2001:569-620.

Stoelting RK, Hiller SC. Nonbarbiturate Intravenous Anesthetic Drugs. Pharmacology & Physiology in Anesthetic Practice. 2006:155-178.

Murdoch S, Cohen A. Intensive care sedation: a review of current British practice. Intensive Care Med. 2000;26:922-928.

Badr AE, Mychaskiw GH 2nd, Eichhorn JH. Metabolic acidosis associated with a new formulation of propofol. Anesthesiology. 2001;94:536-538.

Gear RW, Miaskowski C, Heller PH. Benzodiazepine mediated antagonism of opioid analgesia. Pain. 1997;71:25-29.

Lago PM, Piva JP, Garcia PC. Analgesia e sedação em situações de emergência e unidades de tratamento intensivo pediátrico. J Pediatr (RJ). 2003;79:223-230.

Stoelting RK, Hiller SC. Benzodiazepines. Pharmacology & Physiology in Anesthetic Practice. 2006:140-154.

Anand KJ, Barton BA, McIntosh N. Analgesia and sedation in preterm neonates who require ventilatory support: results from the NOPAIN Trial. Arch Pediatr Adolesc Med. 1999;153:331-338.

Ng E, Taddio A, Ohlsson A. Intravenous midazolam infusion for sedation of infants in the neonatal Intensive Care Unit. Cochrane Database Syst Rev. 2003;1.

Coté CJ. Premedication and induction of anesthesia. ASA Refresher course. 2001;164:1-5.

Montenegro MA, Guerreiro MM, Caldas JP. Epileptic manifestations induced by midazolam in the neonatal period. Arq Neuropsiquiatr. 2001;59:242-243.

Harte GJ, Gray PH, Lee TC. Haemodynamic responses and population pharmacokinetics of midazolam following administration to ventilated, preterm neonates. J Paediatr Child Health. 1997;33:335-338.

Van Straaten HL, Rademaker CM, de Vries LS. Comparison of the effect of midazolam or vecuronium on blood pressure and cerebral blood flow velocity in the premature newborn. Dev Pharmacol. Ther. 1992;19:191-195.

Zaw W, Knoppert DC, da Silva O. Flumazenil's reversal of myoclonic-like movements associated with midazolam in term newborns. Pharmacotherapy. 2001;21:642-646.

Finnegan LP. Neonatal abstinence syndrome: assessment and pharmacotheraphy. Neonatal Therapy: an update. 1986:122-146.

Anand KJ, Hall RW, Desai N. Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet. 2004;363:1673-1682.

Lynn AM, Slattery JT. Morphine pharmacokinetics in early infancy. Anesthesiology. 1987;66:136-139.

McRorie TI, Lynn AM, Nespeca MK. The maturation of morphine clearance and metabolism. Am J Dis Child. 1992;146:972-976.

Stoppa F, Perrotta D, Tomasello C. Low dose remifentanyl infusion for analgesia and sedation in ventilated newborns. Minerva Anestesiol. 2004;70:753-761.

Silva YP, Gomez RS, Marcatto JO. Morphine versus remifentanil for intubation preterm neonates. Arch Dis Fetal Neonatal. 2007;92:F293-294.

Silva YP, Gomez RS, Marcatto JO. Early awakening and extubating with remifentanil in ventilated preterm neonates. Pediatric Anaesthesia. 2007.

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