Juana María Peláez Pérez, Marcelino Sánchez Casado, Manuel Quintana Díaz, Jean Marc Benhaiem, Francisco Javier Escribá Alepuz
Department of Anaesthesia, Division of Pediatria, Puerta del Mar University Hospital of Cádiz, University of Cádiz, 11009 Cádiz, Spain.
Department of Intensive Care, Neurotrauma Critical Care Division, Toledo General University Hospital, University of Castilla-La Mancha, 41007 Toledo, Spain.
Children (Basel). 2021 Dec 17;8(12):1195. doi: 10.3390/children8121195.
Stress in surgical settings has subtle psychological and physiological repercussions in children. The objective is to evaluate whether hypnosedation is effective in reducing the doses of sedation and analgesia required during the periprocedural period in children undergoing dermatological surgery, without negatively affecting pain and satisfaction.
A prospective, longitudinal, observational study where paediatric patients (aged 5-16 years) scheduled for dermatological surgery were analysed according to whether they received hypnosis or distraction during surgery (both common procedures at the centre). As outcome measurements we used sedation doses (propofol) during surgery and the need for analgesia; pain assessment post-surgery and at 24 h using a visual analogue scale (VAS) or revised face pain scale (FPS-r) (both 0-10) depending on age, as well as patient and guardian satisfaction (on a scale of 0-10).
Of the 68 patients eligible during the follow-up period, 65 were included. Of these, 33 were treated with hypnosis and 32 with distraction. Children who underwent hypnosis required less total propofol (45.5 ± 11.8 mg vs. 69.3 ± 16.8 mg; < 0.001) and metamizole in the immediate postoperative period (34.4% vs. 65.6%; = 0.018). After 24 h, they required less ibuprofen (9.1% vs. 28.1%; = 0.048) and paracetamol (48.5% vs. 75.0%; = 0.028). Mean pain according to VAS or FPS-r at 24 h was 3.1 with hypnosis vs. 4.3 with distraction ( < 0.001). Overall satisfaction was higher in the hypnosis group (8.7 ± 0.1 vs. 8.1 ± 0.2; = 0.009).
Hypnoanalgesia in children undergoing dermatological outpatient surgery could not only reduce sedation and analgesia requirements, but also improve child and guardian(s) satisfaction.
手术环境中的压力会对儿童产生微妙的心理和生理影响。目的是评估催眠镇静在减少皮肤科手术儿童围手术期所需镇静和镇痛药物剂量方面是否有效，且不会对疼痛和满意度产生负面影响。
一项前瞻性、纵向观察性研究，根据儿科患者（5 - 16岁）在手术期间是否接受催眠或分散注意力（该中心的常见操作）对计划进行皮肤科手术的患者进行分析。作为结果测量指标，我们使用了手术期间的镇静药物剂量（丙泊酚）和镇痛需求；术后及24小时使用视觉模拟量表（VAS）或根据年龄使用修订面部疼痛量表（FPS - r）（均为0 - 10分）进行疼痛评估，以及患者和监护人的满意度（0 - 10分）。
在随访期间符合条件的68例患者中，纳入了65例。其中，33例接受催眠治疗，32例接受分散注意力治疗。接受催眠的儿童在围手术期所需丙泊酚总量较少（45.5±11.8毫克对69.3±16.8毫克；<0.001），术后即刻所需安乃近较少（34.4%对65.6%；=0.018）。24小时后，他们所需布洛芬较少（9.1%对28.1%；=0.048），对乙酰氨基酚较少（48.5%对75.0%；=0.028）。根据VAS或FPS - r，催眠组24小时时的平均疼痛评分为3.1分，分散注意力组为4.3分（<0.001）。催眠组的总体满意度更高（8.7±0.1对8.1±0.2；=0.009）。
在接受皮肤科门诊手术的儿童中，催眠镇痛不仅可以减少镇静和镇痛需求，还能提高儿童及其监护人的满意度。
