Efectividad de la dexmedetomidina y ketamina en dosis única para sedación en pacientes oncológicos pediátricos
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2023
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Resumen La sedación en procedimientos quirúrgicos para pacientes pediátricos, incluye en el 80% de los casos un manejo invasivo de la vía aérea y mantenimiento con anestésicos inhalatorios que provocan trastornos en el postoperatorio. Por lo tanto, combinar fármacos que permitan una ventilación espontanea, un buen plano anestésico y una recuperación optima se convierte en un desafío para el manejo anestésico de pacientes pediátricos. Objetivo: evaluar la efectividad de la ketamina y dexmedetomidina (ketodex) en dosis única para sedación durante la colocación de dispositivo implantable en pacientes oncológicos pediátricos. Métodos: estudio cuasiexperimental, retrospectivo transversal con enfoque cuantitativo durante el periodo enero hasta septiembre del 2022, a los cuales se le administró dexmedetomidina 1 mcgr/kg y ketamina 1 mg/kg en dosis única. Resultados: 176 pacientes pediátricos conformaron la muestra. La presión arterial sistólica fue: antes = 101.31 mmHg, durante = 118.78 mmHg, después = 99.74 mmHg de la aplicación del ketodex. Así mismo, la presión arterial diastólica fue: antes = 62.32 mmHg, durante = 75.38 mmHg, después = 62.38 mmHg de la aplicación del ketodex. En cuanto a la saturación de oxígeno, no presento variaciones antes, durante y después de la administración del fármaco. Sin embargo, la frecuencia cardiaca presentó una leve variación previo al procedimiento 100.03lpm, durante 81.52lpm y al finalizar 83.51lpm. El 51% de los pacientes se mantuvo dormido, con respuesta lenta al estimulo (infiltración con lidocaína). Conclusión: la administración conjunta de ketodex en dosis única para sedación en pacientes pediátricos oncológicos es segura y eficaz, con mínimas repercusiones hemodinámicas. Palabras claves: ketamina, dexmedetomidina, ketodex, sedación, pediátrico
Abstract Sedation in surgical procedures for pediatric patients includes invasive airway management in 80% of cases and maintenance with inhalational anesthetics that cause postoperative disorders. Therefore, combining drugs that allow spontaneous ventilation, a good anesthetic plane, and optimal recovery becomes a challenge for the anesthetic management of pediatric patients. Objective: to evaluate the effectiveness of single dose ketamine and dexmedetomidine (ketodex) for sedation during implantable device placement in pediatric cancer patients. Methods: quasiexperimental, retrospective, cross-sectional study with a quantitative approach during the period January to September 2022, to which dexmedetomidine 1 mcgr/kg and ketamine 1 mg/kg were administered in a single dose. Results: 176 pediatric patients made up the sample. Systolic blood pressure was: before = 101.31 mmHg, during = 118.78 mmHg, after = 99.74 mmHg after the application of ketodex. Likewise, the diastolic blood pressure was: before = 62.32 mmHg, during = 75.38 mmHg, after = 62.38 mmHg after the application of ketodex. Regarding oxygen saturation, I do not present variations before, during and after the administration of the drug. However, the heart rate presented a slight variation prior to the procedure: 100.03 bpm, 81.52 bpm during the procedure, and 83.51 bpm at the end. 51% of the patients remained asleep, with a slow response to the stimulus (infiltration with lidocaine). Conclusion: the joint administration of ketodex in a single dose for sedation in pediatric cancer patients is safe and effective, with minimal hemodynamic repercussions. Keywords: ketamine, dexmedetomidine, ketodex, sedation, pediatric
Abstract Sedation in surgical procedures for pediatric patients includes invasive airway management in 80% of cases and maintenance with inhalational anesthetics that cause postoperative disorders. Therefore, combining drugs that allow spontaneous ventilation, a good anesthetic plane, and optimal recovery becomes a challenge for the anesthetic management of pediatric patients. Objective: to evaluate the effectiveness of single dose ketamine and dexmedetomidine (ketodex) for sedation during implantable device placement in pediatric cancer patients. Methods: quasiexperimental, retrospective, cross-sectional study with a quantitative approach during the period January to September 2022, to which dexmedetomidine 1 mcgr/kg and ketamine 1 mg/kg were administered in a single dose. Results: 176 pediatric patients made up the sample. Systolic blood pressure was: before = 101.31 mmHg, during = 118.78 mmHg, after = 99.74 mmHg after the application of ketodex. Likewise, the diastolic blood pressure was: before = 62.32 mmHg, during = 75.38 mmHg, after = 62.38 mmHg after the application of ketodex. Regarding oxygen saturation, I do not present variations before, during and after the administration of the drug. However, the heart rate presented a slight variation prior to the procedure: 100.03 bpm, 81.52 bpm during the procedure, and 83.51 bpm at the end. 51% of the patients remained asleep, with a slow response to the stimulus (infiltration with lidocaine). Conclusion: the joint administration of ketodex in a single dose for sedation in pediatric cancer patients is safe and effective, with minimal hemodynamic repercussions. Keywords: ketamine, dexmedetomidine, ketodex, sedation, pediatric
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KETAMINA, DEXMEDETOMIDINA, SEDACION, HOSPITAL SOLCA DE GUAYAQUIL, CANTON GUAYAQUIL, ECUADOR, PEDIATRIA, ESTUDIOS RETROSPECTIVOS