Cantinho Fernando Antônio de Freitas, Silva Antonio Carlos Pereira da
CET, SBA Dr. Rodrigo Gomes Ferreira.
Rev Bras Anestesiol. 2009 Jul-Aug;59(4):396-408. doi: 10.1590/s0034-70942009000400002.
The care of the wounds of major burn patients triggers severe painful stimuli. The objective of this study was to assess the safety and efficacy of different drug combinations in anesthesia for balneotherapy.
After approval by the Ethics Commission, 200 procedures of balneotherapy in 87 major burn adult patients were evaluated. Midazolam was used in all cases. The vials of ketamine were numbered and, therefore, at the time of the use, one did not know whether racemic or S(+)ketamine was being used. Each morning it was decided by drawing lots whether fentanyl would be used or not in the procedures of that day. Patients were included in one of four groups: ISO/sf (S(+) isomer without fentanyl), ISO/cf (S(+) isomer with fentanyl), RAC/sf (racemic ketamine without fentanyl), and RAC/cf (racemic ketamine with fentanyl). The initial doses proposed were as follows: midazolam, 0.06 mg.kg-1; ketamine, 1.0 to 1.1 mg.kg-1; and fentanyl, 0.8 (1/4)g.kg1-1; additional doses were administered as needed.
Only one patient recalled the pain of balneotherapy. In the group that received S(+)ketamine, the use of fentanyl did not bring additional advantages; however, when associated with racemic ketamine, fentanyl reduced the total dose and the number of ketamine boluses. The extension of body surface burned was the main determinant of the severity of post-procedure pain. Reduced pain severity was the main factor considered by patients when grading their satisfaction with the anesthesia.
The four different drug combinations proved to be safe and guaranteed the absence of pain during balneotherapy. Characteristics not directly related to the anesthetics proved to be more important in the incidence of post-procedure pain, which was the main factor considered by major burn patient to define their satisfaction with the anesthesia used.
大面积烧伤患者伤口护理会引发强烈的疼痛刺激。本研究的目的是评估不同药物组合用于水疗麻醉的安全性和有效性。
经伦理委员会批准，对87例成年大面积烧伤患者的200例水疗过程进行了评估。所有病例均使用咪达唑仑。氯胺酮小瓶进行了编号，因此在使用时，不知道使用的是消旋氯胺酮还是S(+)氯胺酮。每天早上通过抽签决定当天的治疗过程中是否使用芬太尼。患者被纳入以下四组之一：ISO/sf（无芬太尼的S(+)异构体）、ISO/cf（有芬太尼的S(+)异构体）、RAC/sf（无芬太尼的消旋氯胺酮）和RAC/cf（有芬太尼的消旋氯胺酮）。建议的初始剂量如下：咪达唑仑，0.06mg·kg⁻¹；氯胺酮，1.0至1.1mg·kg⁻¹；芬太尼，0.8（1/4）μg·kg⁻¹；根据需要给予追加剂量。
只有1例患者回忆起水疗时的疼痛。在接受S(+)氯胺酮的组中，使用芬太尼并没有带来额外的益处；然而，与消旋氯胺酮联合使用时，芬太尼减少了氯胺酮的总剂量和推注次数。烧伤体表面积是术后疼痛严重程度的主要决定因素。疼痛严重程度降低是患者对麻醉满意度分级时考虑的主要因素。
四种不同的药物组合被证明是安全的，并保证了水疗过程中无痛。与麻醉剂没有直接关系的特征在术后疼痛发生率中被证明更为重要，术后疼痛是大面积烧伤患者确定其对所用麻醉满意度的主要因素。
