O efeito da

Guray Demir; Zafer Cukurova; Gulay Eren; Yasemin Tekdos; Oya Hergunsel

doi:10.1590/S0034-70942012000400004

Scientific Article

O efeito da "sedação multifásica" no exame de tomografia computadorizada e ressonância magnética em crianças, pais e anestesiologistas

The effect of "multiphase sedation" in the course of computed tomography and magnetic resonance imaging on children, parents and anesthesiologists

Guray Demir; Zafer Cukurova; Gulay Eren; Yasemin Tekdos; Oya Hergunsel

http://dx.doi.org/10.1590/S0034-70942012000400004 Braz J Anesthesiol, vol.62, n4, p.515-519, 2012

PDF

Downloads: 0

Resumo

JUSTIFICATIVA E OBJETIVOS: O nosso objetivo foi investigar o efeito da "sedação multifásica" em crianças submetidas à Tomografia Computadorizada (TC) ou Ressonância Magnética (RM), em seus pais e nos anestesiologistas responsáveis. "Sedação multifásica" foi definida como "o nível de sedação pretendido obtido com um ou mais agentes através da mesma via ou vias diferentes com mais de uma administração". MATERIAL E MÉTODOS: Cem crianças e seus respectivos pais foram randomicamente designados para um dos dois grupos de estudo. Na fase 1, os pacientes do Grupo I receberam midazolam (0,5 mg.kg-1) em 5 mL de suco de frutas e os pacientes do Grupo II (grupo controle) receberam apenas suco de frutas. Na fase 2, após a canulação intravenosa (iv), bolus de propofol foi administrado para alcançar a sedação adequada para realização do exame de imagem. Os escores de ansiedade das crianças e de seus pais foram registrados usando a escala de Oucher e o IDATE, respectivamente, e a satisfação dos pais foi avaliada pela escala analógica visual (EAV). O número de tentativas para canulação iv, tempo de preparação e quantidade de hipnóticos foram registrados. RESULTADOS: O estado de ansiedade das crianças foi semelhante entre os grupos antes da pré-medicação, porém mais tarde esse nível foi menor no Grupo I. Antes do procedimento, o escore dos pais no IDATE foi semelhante, mas depois foi menor no Grupo I. A satisfação dos pais no Grupo I foi maior que no Grupo II. O número de tentativas de canulação iv e a dose necessária de propofol foi menor no Grupo I. CONCLUSÃO: O procedimento de "sedação multifásica" diminui a dor e a ansiedade das crianças e a ansiedade dos pais, aumentando a sua satisfação. Ele fornece uma sedação confortável e segura, pois possui um processo de preparação curto e sem problemas também para o anestesiologista responsável.

Palavras-chave

ANESTESIA, Especializada, pediátrica, Ansiedade, Ressonância Magnética, SEDAÇÃO, Profunda, Tomografia

Abstract

BACKGROUND AND OBJECTIVES: We aimed to investigate the effect on children undergoing Computed Tomography (CT) or Magnetic Resonance Imaging (MRI), their parents and attending anesthesiologist of "multiphase sedation" which we define as "the intended sedation level achieved with one or more agents through the same or different routes with more than one administration". MATERIAL AND METHODS: One hundred children and their parents were randomly allocated to one of two study groups. In phase 1; in Group I the patients were given midazolam (0.5 mg.kg-1) in 5 mL fruit juice, and the ones in control group (Group II) were given only fruit juice. After intravenous (iv) cannulation; in phase II, boluses of propofol were given to achieve the adequate sedation for imaging. Anxiety scores of children and their parents were recorded using Oucher scale and STAI, respectively, and parental satisfaction was evaluated by visual analogue scale (VAS). The number of attempts for iv cannulation, length of time for preparation, and amount of hypnotics were recorded. RESULTS: Anxiety state of children was similar between groups before premedication, but later it was lower in Group I. Before procedure, STAI score of parents was similar and later it was lower in Group I. Parental satisfaction in Group I was higher. The number of attempts for iv cannulation and required propofol dose was less in Group I. CONCLUSION: "Multiphase sedation" procedure provides children to feel less pain and anxiety, and decreases parental anxiety while increasing their satisfaction. It supplies a comfortable and safe sedation, as it provides a short and problem-free preparation process for the attending anesthetist as well.

Keywords

Anxiety, Child, Deep Sedation, Magnetic Resonance Imaging, Tomography

Referencias

Malviya S, Voepel-Lewis T, Eldevik OP, Rockwell DT, Wong JH, Tait AR. Sedation and general anaesthesia in children undergoing MRI and CT: Adverse events and outcomes. Br J Anaesth. 2000;84(6):743-748.

Formica D, Silvestri S. Biological effects of exposure to magnetic resonance imaging: anoverview. Biomed Eng Online. 2004;22(3).

Haeseler G, Zuzan O, Kohn G, Pienbrak S, Leuwer M. Anaesthesia with midazolam and S(+) ketamine in spontaneously breathing paediatric patients during magnetic resonance imaging. Paediatr Anaesth. 2000;10(5):513-519.

Eric E, Weissend EE, Litman RS. Paediatric anaesthesia outside the operating room. Curr Opin Anaesthesiol. 2001;14(4):437-440.

Voepel-Lewis T, Malviya S, Prochaska G, Tait AR. Sedation failures in childre undergoing MRI and CT: is temperament a factor?. Paediatr Anaesth. 2000;10(3):319-323.

Gooden CK. Anesthesia for magnetic resonance imaging. Curr Opin Anaesthesiol. 2004;17(4):339-342.

Cravero JP, Blike GT. Review of pediatric sedation. Anesth Analg. 2004;99(5):1355-1364.

D'Agostino J, Terndrup TE. Chloral hydrate versus midazolam for sedation of children for neuroimaging: a randomized clinical trial. Pediatr Emerg Care. 2000;16(1):1-4.

Mc CarverMay DG, Kang J, Aouthmany M, Elyon R, Mowery JL, Slovis TL, Kauffman R. Comparison of chloral hydrate and midazolam for sedation of neonates or neuroimaging studies. J Pediatr. 1996;128(4).

De Sanctis Briggs V. Magnetic resonance imaging under sedation in newborns and infants: a study of 640 cases using sevoflurane. Paediatr Anaesth. 2005;15(1):9-15.

Usher AG, Kearney RA, Tsui BC. Propofol total intravenous anesthesia for MRI in children. Paediatr Anaesth. 2005;15(1):23-28.

Jurgens S. Sevoflurane conscious sedation for MRI scanning. Anaesthesia. 2003;58(3):296297.

Usher AG, Kearney RA. Anesthesia for magnetic resonance imaging in children: a survey of Canadian paediatric centres. Can J Anaest. 2003;50(4).

Kain ZN, Mayes LC, O'Connor TZ, Cicchetti DV. Preoperative anxiety in children: Predictors and outcomes. Arch Paediatr Adolesc Med. 1996;150(12):1238-1245.

Spielberger CD, Gorsuch RL, Lushene RE. Manual for the State-Trait Anxiety Inventory. 1970:25-8.

Watson AT, Visram A. Children's preoperative anxiety and postoperative behaviour. Pediatric Anaesthesia. 2003;13(6):188-204.

Kain ZN, Wang SM, Mayes LC, Caramico LA, Hofstadter MB. Distress during the induction of anaesthesia and postoperative behavioral outcomes. Anaesth Analg. 1999;88(5):1042-1047.

Litman RS, Berger AA, Chibber A. An evaluation of preoperative anxiety in a population of parents of infants and children undergoing ambulatory surgery. Pediatric Anaesthesia. 1996;6(6):443-447.

Miller KM, Wysocki T, Cassady JF, Cancel D, Izenberg N. Validation of measures of parents' preoperative anxiety and anesthesia knowledge. Anaesth Analg. 1999;88(2):251-257.

Feld LH, Negus JB, White PF. Oral midazolam preanaesthetic medication in paediatric outpatients. Anaesthesiology. 1990;73(5):831-834.

Kain ZN, Hofstadter MB, Mayes LC, Krivutza DM, Alexander G, Wang SM, Reznick JS. Midazolam-effects on amnesia and anxiety in children. Anaesthesiology. 2000;93(3):676-684.

Levati A, Colombo N, Arosio EM, Savoia G, Tommasino C, Scialfa G, Boselli L. Propofol anaesthesia in spontaneously breathing paediatric patients during magnetic resonance imaging. Acta Anaesthesiol Scand. 1996;40(5):561-565.

Frankville DD, Spear RM, Dyck JB. The dose of propofol required to prevent children from moving during magnetic resonance imaging. Anaesthesiology. 1993;79(5):953-958.

Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. Injury and liability associated with monitored anaesthesia care: a closed claim analysis. Anaesthesiology. 2006;104(2):228-234.

Serafini G, Zadra N. Anaesthesia for MRI in the paediatric patient. Curr Opin Anaesthesiol. 2008;21(4):499-503.