Niveles de sedación y analgesia en paciente quemado sin ventilación mecánica. Hospital Simón Bolívar, 2017-2018

Abstract

Background: Non-fatal burns are one of the causes with the highest rate of morbidity and permanent injury all over the world. Non-fatal burns include the concept of a large burned patient, which is defined as an individual with more than 25% of total burned body surface, representing a challenge in the management of pain. In Colombia about 1% of the population suffers some type of burn. Methods: From a prospective perspective study that aimed to describe the evolution of the levels of sedation and analgesia in patients who underwent a series of sedo-analgesia cycles for bandage change and healing from the different schemes used in the Simón Bolivar Hospital. Results: We found more frequently in male patients, the most frequent cause of death burn was contact with llamas. None of the schemes achieves the optimal levels of analgesia and, in addition, there is an increase in pain plus hemodynamic changes 15 minutes after the start of the procedure with all the analgesia schemes used; however, apparently, a better pain control in the schemes that use Ketamine / Remifentanil compared to the other analgesia schemes. Conclusion: In the observation it was found that there is not advantages for using one medicine over the other, within the schemes used, a pharmacological combination that allowed obtaining and maintaining the optimal levels of analgesics during the healing of the burned patient. It is necessary to continue with research to find the ideal drug, taking into account the appropriate options for the drugs, the amount of analgesics suitable for carrying out the procedures in the patient who cannot reach to produce greater hemodynamic changes or an appearance of adverse effects to the used drugs. However, the study allowed to characterize the levels of sedation - analgesia and to estimate the adverse events associated with each of the pharmacological schemes used.