Eficacia analgésica de la Ketamina en cirugía de hernias en pacientes pediátricos Hospital Francisco de Icaza Bustamante 2010
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2010
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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En el paciente pediátrico, conseguir un buen control analgésico, alta capacidad disociativa y un despertar postquirúrgico rápido con una baja tasa de efectos colaterales en cirugías de corta duración es un anhelo. La ketamina es un fármaco de estructura mejorada que permite lograr la mayoría de estos propósitos, sin embargo una tasa elevada de efectos colaterales se ha detectado en dosis de 0.5 a 2 mg/kg de peso. En el Hospital “Francisco de Icaza Bustamante” esta droga es frecuentemente utilizada en intervenciones quirúrgicas breves como las herniorrafias, y se habían reportado un 18% de complicaciones con esta dosificación. Con el objetivo de conocer si la dosis de 0.15 mg/kg de ketamina IV provee mejores resultados analgésicos para la realización de cirugías de hernias en pacientes pediátricos se realizó un estudio de tipo observacional, correlacional, de diseño experimental, prospectivo, que comparó 42 pacientes dosificados con 0.5-2 mg/kg y 41 pacientes dosificados con una dosis alternativa de 0.15 mg/kg. Para el análisis estadístico se utilizó prueba t y z considerándose significativos valores de P < 0.05. El análisis de impacto mediante el cálculo de la Reducción del Riesgo Absoluto (RRA) y el Odds Ratio (OR) también se efectuó. Los resultados mostraron que el uso de ketamina a dosis de 0,15 mg/kg de peso para cirugía de hernias en pacientes pediátricos ofrece similares beneficios en relación al control del dolor posquirúrgico, transquirúrgico, rescate analgésico y parámetros de signos vitales que una dosis estándar de 1 a 2 (P > 0.05), pero con menores efectos colaterales (P = 0.04), y una reducción importante de complicaciones (RRA = 17-19; IC95% 2.98 – 31.40), así como una disminución del riesgo indirecto de presentarlos (OR = 0.178; IC 95% 0.036 –0.882).
In pediatric patients, to achieve good pain control, high dissociative ability and rapid postoperative awakening with a low rate of side effects in shortterm surgery is a dream. Ketamine is a drug with improved structure that achieves most of these purposes, however a high rate of side effects has been achieved at recommended doses from 0.5 to 2 mg / kg. In the Francisco de Icaza Bustamante hospital this drug is often used in short surgical procedures such as herniorrhaphy, and had reported a 18% complication rate with this dosage. In order to know if the dose of 0.15 mg / kg of ketamine IV anesthetic provides better results for the performance of hernia surgery in pediatric patients, a study of observational, correlational, experimental, prospective, study that compared 42 patients dosed with 0.5 to 2 mg / kg and 41 patients dosed with an alternative dose of 0.15 mg / kg. For statistical analysis t and z test was used considering significant values of P <0.05. The impact analysis by calculating the absolute risk reduction (ARR) and odds ratio (OR) also was performed. The results showed that ketamine at a dose of 0.15 mg / kg for hernia surgery in pediatric patients offers similar benefits with respect to postoperative pain control, transsurgical, rescue analgesia and vital signs parameters of a standard dose of 1-2 (P> 0.05), but with fewer side effects (P = 0.04), and a significant reduction of complications (ARR = 17-19, 95% CI 2.98 - 31.40) and a decreased risk of presenting indirect (OR = 0.178, 95% CI 0036-0882).
In pediatric patients, to achieve good pain control, high dissociative ability and rapid postoperative awakening with a low rate of side effects in shortterm surgery is a dream. Ketamine is a drug with improved structure that achieves most of these purposes, however a high rate of side effects has been achieved at recommended doses from 0.5 to 2 mg / kg. In the Francisco de Icaza Bustamante hospital this drug is often used in short surgical procedures such as herniorrhaphy, and had reported a 18% complication rate with this dosage. In order to know if the dose of 0.15 mg / kg of ketamine IV anesthetic provides better results for the performance of hernia surgery in pediatric patients, a study of observational, correlational, experimental, prospective, study that compared 42 patients dosed with 0.5 to 2 mg / kg and 41 patients dosed with an alternative dose of 0.15 mg / kg. For statistical analysis t and z test was used considering significant values of P <0.05. The impact analysis by calculating the absolute risk reduction (ARR) and odds ratio (OR) also was performed. The results showed that ketamine at a dose of 0.15 mg / kg for hernia surgery in pediatric patients offers similar benefits with respect to postoperative pain control, transsurgical, rescue analgesia and vital signs parameters of a standard dose of 1-2 (P> 0.05), but with fewer side effects (P = 0.04), and a significant reduction of complications (ARR = 17-19, 95% CI 2.98 - 31.40) and a decreased risk of presenting indirect (OR = 0.178, 95% CI 0036-0882).
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Pediatría, Hernia, Anestesia, Ketamina, Estudios prospectivos, Hospital del Niño Francisco de Icaza Bustamante, Cantón Guayaquil, Ecuador, Cirugía, Resultado del tratamiento