Escolar Documentos
Profissional Documentos
Cultura Documentos
Contenidos
Introduccin
Temores
Factores Predisponentes
Reacciones segn edades
Ansiedad, Outcome y situacin perioperatoria
Escalas de ansiedad
Manejo por el Anestesilogo
Tratamiento Farmacolgico y No Farmacolgico
Conclusiones
Introduccin
> 40% de los nios entre 2-10 aos presentan algn
Y. Sun et al. Is dexmedetomidine superior to midazolam as a premedication in children? A metaanalysis of randomized controlled trials, Pediatric Anesthesia 24 (2014) 863874
Temores
Separacin
de los
padres
Ambiente
desconocido
Dolor
Ciruga
Anestesia
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative Child,
Continuing Education in Anaesthesia, Critical Care & Pain | 2010
Factores predisponentes
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative Child,
Continuing Education in Anaesthesia, Critical Care & Pain | 2010
1-3 aos
3-6 aos
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative Child, Continuing Education
in Anaesthesia, Critical Care & Pain | 2010
7-12 aos
Adolescentes
Alt. Mentales
Desarrollo
Conductuales
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative Child, Continuing Education
in Anaesthesia, Critical Care & Pain | 2010
Ansiedad y situacin
perioperatoria
M.A. Fortier et al. Perioperative anxiety in children, Pediatric Anesthesia 2010, 20: 318322
Ansiedad y Outcomes
> dolor a las 24 hr.
> requerimientos
analgsicos
> delirium
postoperatorio
Alt. Conductuales:
Ansiedad
generalizada,
ansiedad de
separacin
Enuresis
Llanto nocturno
Rabietas
Alt. apetito
M.A. Fortier et al. Perioperative anxiety in children, Pediatric Anesthesia 2010, 20: 318322
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative Child, Continuing Education
in Anaesthesia, Critical Care & Pain | 2010
Davidson and McKenzie, Distress at induction: prevention and consequences, Current Opinion in Anesthesiology 2011,
24:301306
Strom, Preoperative evaluation, premedication, and induction of anesthesia in infants and children, Curr Opin
Anesthesiol 2012, 25:321325
Escalas Ansiedad
Escalas ms usadas STAI y m-YPAS
Escala de ansiedad de Yale modificada (mPYAS)
fue desarrollada en 1995, modificada 1997
mide 5 items, validada.
STAI es dificultosa de realizar en el ambiente clnico
Davidson and McKenzie, Distress at induction: prevention and consequences, Current Opinion in
Anesthesiology 2011, 24:301306
Brooke N. Jenkins, MS,* Michelle A. Fortier, PhD, et al. Development of a Short Version of the Modified
Yale Preoperative Anxiety Scale, Anesthesia & Analgesia, September 2014, Volume 11, Number 3
Brooke N. Jenkins, MS,* Michelle A. Fortier, PhD, et al. Development of a Short Version of the
Modified Yale Preoperative Anxiety Scale, Anesthesia & Analgesia, September 2014, Volume 11, Number
3
Davidson and McKenzie, Distress at induction: prevention and consequences, Current Opinion in
Anesthesiology 2011, 24:301306
Manejo Anestsico
Pre medicacin con sedantes
Presencia de los padres en la induccin
Intervenciones conductuales
Michael OSullivan MRCS FCA(RCSI), Gail K Wong FANZCA, Preinduction techniques to relieve
anxiety in children undergoing general anaesthesia, Continuing Education in Anaesthesia, Critical
Care & Pain j Volume 13 Number 6 2013
Manejo No Farmacolgico
-Cognitivas
-Terapia de juego
-Ambientales
-Modificacin de equipamiento
-Intervenciones sociales
-Programas pre-hospitalarios
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative Child, Continuing
Education in Anaesthesia, Critical Care & Pain | 2010
Davidson and McKenzie, Distress at induction: prevention and consequences, Current Opinion in Anesthesiology 2011,
24:301306
Michael OSullivan MRCS FCA(RCSI), Gail K Wong FANZCA, Preinduction techniques to relieve anxiety in children
undergoing general anaesthesia, Continuing Education in Anaesthesia, Critical Care & Pain j Volume 13 Number 6 ,2013
Presencia de padres
-Controversial
-Presencia de padres con alto nivel de ansiedad puede
resultar:
-Aumento ansiedad del nio
-Induccin anestsica prolongada
-Estrs adicional para el anestesista
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative Child, Continuing
Education in Anaesthesia, Critical Care & Pain | 2010
Davidson and McKenzie, Distress at induction: prevention and consequences, Current Opinion in Anesthesiology
2011, 24:301306
Michael OSullivan MRCS FCA(RCSI), Gail K Wong FANZCA, Preinduction techniques to relieve anxiety in children
undergoing general anaesthesia, Continuing Education in Anaesthesia, Critical Care & Pain j Volume 13 Number 6 ,2013
Manejo Farmacolgico
-Reservadas para nios no cooperadores
-Las vas ms comunes : vo, intranasal y rectal.
-VO en caso de contar con acceso VVP
-IM en caso de nio combativo (absorcin errtica)
Consideraciones:
-Rechazo de la droga
-Fallar o causar una reaccin paradojal
-Obstruccin de VA, depresin respiratoria en lugares no
monitorizados
-Necesidad de mayor equipamiento, personal de
enfermera
BDZ:Midazolam
-Pre medicacin ms comn en nios
-Benzodiacepina hidrosoluble
Ventajas: rpido inicio de accin, sedacin efectiva,
amnesia anterograda, ansiolisis.
Desventajas: reaccin paradojal (<1%), sabor amargo
Dosis:
-Oral 0,5- 0,75 mg/kg efecto 5-10 min, peak 20-30 min
-Intranasal 0,2 mg/kg
-Sublingual 0,2 mg/kg
-I.V:0,1- 0,2 mg/kg
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative Child, Continuing
Education in Anaesthesia, Critical Care & Pain | 2010
Strom, Preoperative evaluation, premedication, and induction of anesthesia in infants and children, Curr Opin
Anesthesiol 2012, 25:321325
Agonistas alfa2
Clonidina:
-Sedacin y analgesia
-Ventajas: bien tolerado, efecto predecible, beneficiosa en
dolor crnico
-Desventajas: Lento inicio de accin (45 min)
Dosis:
Oral 4 mcg/kg
Intranasal 2 mcg/kg
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative
Child, Continuing Education in Anaesthesia, Critical Care & Pain | 2010
Strom, Preoperative evaluation, premedication, and induction of anesthesia in infants and
children, Curr Opin Anesthesiol 2012, 25:321325
Agonistas alfa2
Dexmedetomidina
-Potente y selectivo agonista alfa dos (1600:1)
-Sedacin y analgesia.
-Vida media corta
-Desventaja: inicio de accin
-Dosis: (Nunca en Bolo)
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative
Child, Continuing Education in Anaesthesia, Critical Care & Pain | 2010
Strom, Preoperative evaluation, premedication, and induction of anesthesia in infants and
children, Curr Opin Anesthesiol 2012, 25:321325
Y. Sun et al. Is dexmedetomidine superior to midazolam as a premedication in children? A metaanalysis of randomized controlled trials, Pediatric Anesthesia 24 (2014) 863874
Ketamina
-Bloqueador receptor NMDA
-Ansioltico, analgsico, sedacin
-Liposoluble, rpida absorcin i.v, im, intranasal y oral
Desventaja: Aumento secreciones, hiperventilacin,
alucinaciones
Dosis:
VO 5-8 mg/kg inicio 10.15 min
IM 4-8 mg/kg nio combativo
EV 1-2 mg/kg
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative Child, Continuing
Education in Anaesthesia, Critical Care & Pain | 2010
Strom, Preoperative evaluation, premedication, and induction of anesthesia in infants and children, Curr Opin
Anesthesiol 2012, 25:321325
Otros
Fentanilo
-Rpida absorcin va tansmucosa
-Inicio de accin 15-20 min
-Se asocia a depresin respiratoria, prurito y aumento
PONV
Dosis:
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative Child, Continuing
Education in Anaesthesia, Critical Care & Pain | 2010
Strom, Preoperative evaluation, premedication, and induction of anesthesia in infants and children, Curr Opin
Anesthesiol 2012, 25:321325
Conclusiones
-Fundamental identificar a los pacientes con factores
predisponentes
-Disminuir los tiempos de situaciones ms estresantes
(separacin, induccin, etc.)
-Prevenir Disminuir outcome adversos
-Evaluar caso a caso presencia de padres
Biliografa
Y. Sun et al. Is dexmedetomidine superior to midazolam as a premedication in children? A metaanalysis of randomized controlled trials, Pediatric Anesthesia 24 (2014) 863874
Lena Tan BMBS MRCP FRCA, George H Meakin MD FRCA, Anaesthesia for the uncooperative Child,
Continuing Education in Anaesthesia, Critical Care & Pain | 2010
M.A. Fortier et al. Perioperative anxiety in children, Pediatric Anesthesia 2010, 20: 318322
Davidson and McKenzie, Distress at induction: prevention and consequences, Current Opinion in
Anesthesiology 2011, 24:301306
Michael OSullivan MRCS FCA(RCSI), Gail K Wong FANZCA, Preinduction techniques to relieve anxiety
in children undergoing general anaesthesia, Continuing Education in Anaesthesia, Critical Care & Pain j
Volume 13 Number 6 2013
Bibliografa
Peggy Yip, Philippa Middleton, Allan M Cyna, Alison V Carlyle, Non-pharmacological interventions for
assisting the induction of anaesthesia in children, The Cochrane Library 2010, Issue 11
F. Rangel vila et al, La ansiedad de los padres incrementa la ansiedad preoperatoria en el paciente
peditrico cuando este va a someterse a ciruga ambulatoria, Rev Esp Anestesiol Reanim. 2012;59(2):8390
Strom, Preoperative evaluation, premedication, and induction of anesthesia in infants and children,
Curr Opin Anesthesiol 2012, 25:321325
Lerman, Preoperative assessment and premedication in Paediatrics, Eur J Anaesthesiol 2013; 30:645650
Brooke N. Jenkins, MS,* Michelle A. Fortier, PhD, et al. Development of a Short Version of the Modified
Yale Preoperative Anxiety Scale, Anesthesia & Analgesia, September 2014, Volume 11, Number 3
FIN