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Master's Dissertation
DOI
10.11606/D.7.2006.tde-03102006-111524
Document
Author
Full name
Mariana Bueno
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2006
Supervisor
Committee
Kimura, Amélia Fumiko (President)
Pimenta, Cibele Andrucioli de Mattos
Vale, Ianê Nogueira do
Title in Portuguese
Dor e analgesia em recém-nascidos submetidos a cirurgias cardíacas.
Keywords in Portuguese
Analgesia
Cardiopatias congênitas (cirurgia)
Dor
Recém-nascido
Abstract in Portuguese
A dor ocasiona uma série de alterações sistêmicas que afetam o desenvolvimento do recém-nascido (RN), em particular, os submetidos à cirurgia cardíaca, além de acarretar alterações hemodinâmicas que podem comprometer sua sobrevivência. O objetivo do estudo foi caracterizar a população de neonatos submetidos a cirurgias cardíacas e descrever as práticas de controle da dor implementadas no primeiro pós-operatório. Estudo descritivo, transversal realizado na Sociedade Hospital Samaritano de São Paulo. Os dados foram obtidos de prontuários médicos de RN submetidos à cirurgia cardíaca, internados entre julho de 2001 e dezembro de 2005. Os registros sobre a avaliação da dor e intervenção medicamentosa para o alívio da dor no primeiro pós-operatório foram analisados. Dentre quarenta e dois RN submetidos a cirurgias cardíacas no período estudado, 30 atenderam aos critérios de inclusão e constituíram a casuística do estudo. A maioria dos RN nasceu a termo, pesava 2.500g ou mais na data do procedimento cirúrgico e foi submetida à cirurgia na primeira semana de vida. Foram identificados 24 diferentes diagnósticos de cardiopatias congênitas e 14 tipos de intervenções cirúrgicas, corretivas ou paliativas, no grupo estudado. Dentre 30 prontuários, foram identificados registros de avaliação de dor em 24 (80,0%). A avaliação por meio da escala NIPS foi anotada em 17 (56,7%) prontuários e em 15 (50,0%) verificou-se registro de comportamentos e alterações nos parâmetros fisiológicos indicativos de dor. Dos RN avaliados, 17 (56,7%) apresentaram registro de ocorrência de dor no primeiro pós-operatório. A maioria, 29 (96,7%), recebeu analgesia farmacológica: 24 (80,0%) RN receberam citrato de fentanil contínuo, 5 (16,7%) RN, dipirona intermitente, 5 (16,7%) RN, citrato de fentanil contínuo e dipirona intermitente, 1 (3,3%) RN recebeu citrato de fentanil contínuo e morfina intermitente. As doses administradas variaram amplamente. Foram também utilizados sedativos associados aos analgésicos: 12 (40,0%) RN receberam midazolan contínuo, 5 (16,7%) RN, midazolan intermitente, 1 (3,3%), besilato de cisatracúrio contínuo, 1 (3,3%) cloridrato de clorpromazina contínuo e 1 (3,3%) propofol intermitente Os resultados evidenciam não haver uniformidade e padronização na avaliação da dor pós-operatória e nos tipos e doses de fármacos utilizados para o controle da dor pós-operatória dos RN submetidos a cirurgias cardíacas no serviço estudado.
Title in English
Pain and analgesia in newborns who underwent cardiac surgery.
Keywords in English
Analgesia
Congenital heart disease (surgery)
Newborn
Pain
Abstract in English
Pain causes several systemic alterations that affect the newborn’s development, specially the ones who underwent cardiac surgery. Besides, hemodynamic alterations related to pain can put their lives into risk. The aim of the study was to characterize pain control practices in newborns who underwent cardiac surgery. This is a cross-sectional and descriptive study performed in Sociedade Hospital Samaritano of São Paulo. The data were collected from the medical reports of the newborns who underwent cardiac surgery from July 2001 to December 2005. The records related to pain assessment and pharmacological treatment in the first post-operative day were analyzed. From 42 newborns who underwent cardiac surgery during the period studied, 30 of them were in accordance with the criteria of inclusion. Most of the neonates were term and their weights were 2.500 grams or more on the date of the surgery that was mostly performed in the first week of life. In the studied group, it was identified 24 different diagnoses of congenital heart deffects and 14 types of corrective or palliative surgical interventions. From the 30 medical reports, records of pain assessment were found in 24 of them (80.0%). The evaluations taken by using the NIPS were written in 17 medical reports (56.7%) and in 15 of them (50.0%) it was verified records of behavior and physiological parameters alterations that indicate pain. From the newborns evaluated, 17 (56.7%) presented records of pain in the first day post-surgery. 29 neonates (96.7%) received analgesics, as it follows: continuous fentanyl citrate, 24 newborns (80.0%); intermittent dipyrone, 5 (16.7%); continuous fentanyl citrate and intermittent dipyrone, 5 (16.7%) and fentanyl citrate and intermittent morphine, 1 (3.3%). The doses given to the neonates were very different. 12 (40.0%) newborns received the sedative midazolam by continuous infusion with analgesics. 5 (16.7%) neonates received intermittent midazolam, 1 (3.3%) received continuous cisatracurium besylate, 1 (3.3%) received continuous chlorpromazine hydrochloride and 1 (3.3%) received intermittent propofol. The results showed that there is no pattern and uniformity of pain assessment after surgery, neither of the types and doses of drugs used for pain control of the newborns who underwent cardiac surgery in the service that was studied.
 
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Mariana_Bueno.pdf (689.71 Kbytes)
Publishing Date
2006-11-17
 
WARNING: The material described below relates to works resulting from this thesis or dissertation. The contents of these works are the author's responsibility.
  • BUENO, Mariana, and KIMURA, Amélia Fumiko. Perfil de recém-nascidos submetidos à cirurgia cardíaca em hospital privado do Município de São Paulo [doi:10.1590/S0080-62342008000100015]. Revista da Escola de Enfermagem da USP [online], 2008, vol. 42, n. 1, p. 112-119.
  • BUENO, Mariana, KIMURA, Amélia Fumiko, and PIMENTA, Cibele Andrucioli de Mattos. Pharmacological analgesia in neonates undergoing cardiac surgery [doi:10.1590/S0104-11692008000400012]. Revista Latino-Americana de Enfermagem [online], 2008, vol. 16, n. 4, p. 727-732.
  • BUENO, Mariana, KIMURA, Amélia Fumiko, e PIMENTA, Cibele Andrucioli de Matos. Avaliação da dor em recém-nascidos submetidos à cirurgia cardiáca [doi:10.1590/S0103-21002007000400007]. Acta Paulista de Enfermagem [online], 2007, vol. 20, n. 4, p. 428-433.
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