Análise da anestesia sob ventilação não invasiva para troca de curativos em pacientes queimados em unidade de terapia intensiva de Curitiba /PR
Tipo
TCC
Data de publicação
2025-06-05
Periódico
Citações (Scopus)
Autores
Abreu, Henrique Guetter
Machado, Mariana Beleski
Machado, Mariana Beleski
Orientador
Frank, Claudio Luciano
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Introdução: Em pacientes grandes queimados, a dor procedimental é intensa e demanda abordagens anestésicas que promovam controle clínico adequado, com atenção ao risco respiratório sob ventilação não invasiva. Objetivos: Evidenciar os medicamentos e dosagens utilizados na troca de curativo de pacientes grandes queimados sob cuidados intensivos, submetidos à anestesia geral venosa com ventilação não invasiva. Métodos: Um estudo transversal, analítico e observacional de relatórios preenchidos durante e após a troca de curativos sob anestesia geral com ventilação não invasiva de pacientes queimados internados em uma UTI em Curitiba-PR. Os dados incluíram parâmetros clínicos, medicamentos e doses administrados, efeitos adversos observados durante e uma hora após o procedimento com a análise das escalas: Early Comfort using Analgesia, Minimal sedatives and Maximal human care (eCASH), Richmond Agitation-Sedation Scale (RASS) e Escala Visual Analógica (EVA). Resultados: Utilizou-se endovenoso para indução anestésica 0,2 mg/kg de midazolam, 2,0 mcg/kg de fentanil, 0,8 mg/kg de cetamina e 0,8 mg/kg de propofol. Para manutenção manteve-se em infusão contínua, 0,025 mcg/kg/min de fentanil, 12 mcg/kg/min de cetamina e 29 mcg/kg/min de propofol. Aplicou-se para analgesia pós-procedimento, 0,13 mg/Kg de metadona. Utilizou-se ventilação não invasiva (VNI) no modo ventilação com pressão controlada (PCV). O tempo de procedimento médio foi de 51 minutos, destes 38 minutos para a troca de curativos e 13 minutos para despertar. A média de idade foi de 36,9 anos, a porcentagem média de superfície corporal queimada (%SCQ) foi de 40,1% com queimaduras de terceiro grau em 100% dos casos. Constatou-se a incidência de náuseas (11,5%), vômitos (3,3%), dissociação córtico-talâmico (5%) e hipertensão (1,6%). Observou-se que uma hora após o procedimento 85% dos pacientes apresentaram dor leve com EVA ≤ 3, 95% apresentaram RASS ideal de -1 e 0, e 90% dos procedimentos alcançaram os 3C’s (Calmos, Confortáveis e Colaborativos) conforme os critérios do eCASH. Correlacionou-se: 3C's com EVA ≤ 3 em 96,2% ( p < 0,001); RASS -1 ou 0 com EVA ≤ 3 em 89,7% (p = 0,002), 3C's com RASS -1 ou 0 em 100% (p = 0,002). Conclusão: Na análise da anestesia sob ventilação não invasiva para troca de curativos em pacientes queimados em unidade de terapia intensiva, evidenciou-se que a anestesia balanceada com midazolam, fentanil, cetamina, propofol e analgesia com metadona, resulta predominantemente em EVA ≤ 3, RASS -1 e 0 associados aos 3C's, uma hora após o procedimento.
Introduction: In patients with major burn injuries, procedural pain is intense and requires anesthetic approaches that ensure adequate clinical control, with attention to respiratory risk under non-invasive ventilation. Objectives: To identify the medications and dosages used during dressing changes in critically ill burn patients undergoing intravenous general anesthesia with non-invasive ventilation. Methods: This was a cross-sectional, analytical, and observational study based on reports completed during and after dressing changes under general anesthesia with non-invasive ventilation in burn patients admitted to an ICU in Curitiba, Brazil. Data included clinical parameters, medications, and doses administered, adverse effects observed during and one hour after the procedure, and evaluations using the Early Comfort using Analgesia, Minimal Sedatives and Maximal Human Care (eCASH) scale, the Richmond Agitation-Sedation Scale (RASS), and the Visual Analog Scale (EVA). Results: For anesthetic induction, intravenous doses used were: 0.2 mg/kg midazolam, 2.0 mcg/kg fentanyl, 0.8 mg/kg ketamine, and 0.8 mg/kg propofol. For maintenance, continuous infusion of 0.025 mcg/kg/min fentanyl, 12 mcg/kg/min ketamine, and 29 mcg/kg/min propofol was used. Post-procedural analgesia included 0.13 mg/kg methadone. Non-invasive ventilation (NIV) in pressure-controlled ventilation (PCV) mode was applied. The average procedure time was 51 minutes—38 minutes for dressing change and 13 minutes for awakening. The mean patient age was 36.9 years, with a mean total body surface area burned (%TBSA) of 40.1%, and 100% with third-degree burns. Adverse effects included nausea (11.5%), vomiting (3.3%), cortical-thalamic dissociation (5%), and hypertension (1.6%). One hour after the procedure, 85% of patients reported mild pain (EVA ≤ 3), 95% had an ideal RASS score of -1 or 0, and 90% achieved the 3Cs (Calm, Comfortable, and Cooperative) per eCASH criteria. Correlations included: 3Cs with EVA ≤ 3 in 96.2% (p < 0.001); RASS -1 or 0 with EVA ≤ 3 in 89.7% (p = 0.002); and 3Cs with RASS -1 or 0 in 100% (p = 0.002). Conclusion: In the context of dressing changes under non-invasive ventilation in burn ICU patients, balanced anesthesia with midazolam, fentanyl, ketamine, propofol, and methadone was predominantly associated with EVA ≤ 3, RASS -1 or 0, and achievement of the 3Cs one hour after the procedure.
Introduction: In patients with major burn injuries, procedural pain is intense and requires anesthetic approaches that ensure adequate clinical control, with attention to respiratory risk under non-invasive ventilation. Objectives: To identify the medications and dosages used during dressing changes in critically ill burn patients undergoing intravenous general anesthesia with non-invasive ventilation. Methods: This was a cross-sectional, analytical, and observational study based on reports completed during and after dressing changes under general anesthesia with non-invasive ventilation in burn patients admitted to an ICU in Curitiba, Brazil. Data included clinical parameters, medications, and doses administered, adverse effects observed during and one hour after the procedure, and evaluations using the Early Comfort using Analgesia, Minimal Sedatives and Maximal Human Care (eCASH) scale, the Richmond Agitation-Sedation Scale (RASS), and the Visual Analog Scale (EVA). Results: For anesthetic induction, intravenous doses used were: 0.2 mg/kg midazolam, 2.0 mcg/kg fentanyl, 0.8 mg/kg ketamine, and 0.8 mg/kg propofol. For maintenance, continuous infusion of 0.025 mcg/kg/min fentanyl, 12 mcg/kg/min ketamine, and 29 mcg/kg/min propofol was used. Post-procedural analgesia included 0.13 mg/kg methadone. Non-invasive ventilation (NIV) in pressure-controlled ventilation (PCV) mode was applied. The average procedure time was 51 minutes—38 minutes for dressing change and 13 minutes for awakening. The mean patient age was 36.9 years, with a mean total body surface area burned (%TBSA) of 40.1%, and 100% with third-degree burns. Adverse effects included nausea (11.5%), vomiting (3.3%), cortical-thalamic dissociation (5%), and hypertension (1.6%). One hour after the procedure, 85% of patients reported mild pain (EVA ≤ 3), 95% had an ideal RASS score of -1 or 0, and 90% achieved the 3Cs (Calm, Comfortable, and Cooperative) per eCASH criteria. Correlations included: 3Cs with EVA ≤ 3 in 96.2% (p < 0.001); RASS -1 or 0 with EVA ≤ 3 in 89.7% (p = 0.002); and 3Cs with RASS -1 or 0 in 100% (p = 0.002). Conclusion: In the context of dressing changes under non-invasive ventilation in burn ICU patients, balanced anesthesia with midazolam, fentanyl, ketamine, propofol, and methadone was predominantly associated with EVA ≤ 3, RASS -1 or 0, and achievement of the 3Cs one hour after the procedure.
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Palavras-chave
anestesia e analgesia , queimaduras , manejo da dor , cuidados críticos , ventilação não invasiva , anesthesia and analgesia , burns , pain management , critical care , non-invasive ventilation