Analgesia and sedation in children admitted to hospital: an integrative review
DOI:
https://doi.org/10.55892/jrg.v8i18.1906Keywords:
Sedation, Conscious; Analgesia; ChildAbstract
Analgesia and sedation are crucial in the management of hospitalized children, especially during invasive and painful procedures. The aim of this study was to review analgesia and sedation practices in hospitalized children. This is an integrative review, which includes articles published in English between 2013 and 2023 in PubMed, using the Medical Subject Headings (MeSH) descriptors: (Conscious Sedation OR Deep Sedation) AND Analgesia) AND Child) OR Infant AND Clinical Protocols AND Respiration, Artificial). Eight publications were reviewed, and the drugs cited included opioids, benzodiazepines, nonsteroidal anti-inflammatory drugs, and dissociative anesthetics. The choice of medication depends on the desired level of sedation, ranging from minimal to deep sedation, requiring the use of assessment scales for proper monitoring. The reviewed literature indicates that the combination of fentanyl and midazolam is widely used, while alternatives such as dexmedetomidine and ketamine show significant efficacy in certain contexts. Furthermore, drug rotation and the use of clinical protocols may reduce complications, such as withdrawal syndrome and prolonged hospitalization. Therefore, pediatric analgesia and sedation should be individualized, ensuring safety and effectiveness in hospital care.
Downloads
References
ARAÚJO, Maylla et al. Profile of the use of sedoanalgesia in children under mechanical ventilation in an intensive care unit. Residência Pediátrica, [s.l.], v. 9, n. 3, p. 246-251, 2019. Residencia Pediatrica. http://dx.doi.org/10.25060/residpediatr-2019.v9n3-09.
ASA. American Society Of Anesthesiologists (org.). Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: a report by the american society of anesthesiologists task force on moderate procedural sedation and analgesia, the american association of oral and maxillofacial surgeons, american college of radiology, american dental association, american society of dentist anesthesiologists, and society of interventional radiology. Anesthesiology, v. 128, n. 3, p. 437-479, mar. 2018. Disponível em: https://journals.lww.com/anesthesiology/fulltext/2018/03000/practice_guidelines_for_moderate_procedural.11.aspx. Acesso em: 13 fev. 2025.
BARCELOS, Andrea Lucia Machado; PIVA, Jefferson Pedro. Sedação e analgesia em emergência pediátrica. Scientia Medica, Porto Alegre, v. 22, n. 3, p. 153-161, maio 2012. Disponível em: https://revistaseletronicas.pucrs.br/scientiamedica/article/view/10456/8187. Acesso em: 13 fev. 2025.
BRASIL. Guia de elaboração de protocolos clínicos e diretrizes terapêuticas: delimitação do escopo. 2. ed. Brasília: Ministério da Saúde, 2019. 31 p. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/guia_elaboracao_protocolos_delimitacao_escopo_2ed.pdf. Acesso em: 05 out. 2023.
BRESOLIN, Nilzete Liberato; FERNANDES, Vera Regina. Sedação, analgesia e bloqueio neuromuscular. 2008. AMIB. Disponível em: https://www.sbp.com.br/fileadmin/user_upload/pdfs/Sedacao_Analgesia_Bloqueio_Neuromuscular.pdf. Acesso em: 05 out. 2023.
BROWN, James J. et al. Procedural sedation in children with autism spectrum disorders in the emergency department. The American Journal Of Emergency Medicine, [S.L.], v. 37, n. 8, p. 1404-1408, ago. 2019. Elsevier BV. http://dx.doi.org/10.1016/j.ajem.2018.10.025. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0735675718308398?via%3Dihub. Acesso em: 13 fev. 2025.
CASTILLA, José Domingo López et al. Midazolam/fentanyl vs. propofol/remifentanil in immediate postoperative with short-term mechanical ventilation. Anales de Pediatría: English Edition, [S.L.], v. 96, n. 2, p. 115-121, fev. 2022. Http://dx.doi.org/10.1016/j.anpede.2020.11.013. Disponível em: http://dx.doi.org/10.1016/j.anpede.2020.11.013. Acesso em: 13 fev. 2025.
CHEVRAND, Felipe Stroligo. Sedoanalgesia do paciente crítico: avaliação da dor,do nível de consciência e tendências atuais de prescrição. 2021. 31 f. TCC (Graduação) - Curso de Faculdade de Medicina, Universidade Federal Fluminense, Nitéroi, 2021. Disponível em: https://app.uff.br/riuff/bitstream/handle/1/24955/TCC%20Felipe%20Stroligo.pdf?sequence=1&isAllowed=y. Acesso em: 05 out. 2023.
EBSERH. Empresa Brasileira de Serviços Hospitalares (org.). Sedação e analgesia em pediatria. 2. ed. Uberaba: Universidade Federal do Triângulo Mineiro, 2021. 15 p. (Protocolos clínicos). Disponível em: https://www.gov.br/ebserh/pt-br/hospitais-universitarios/regiao-sudeste/hc-uftm/documentos/protocolos-assistenciais/59PRT.DM.003SedaoeAnalgesiaemPediatriaverso2.pdf. Acesso em: 05 out. 2023.
EBSERH. Empresa Brasileira de Serviços Hospitalares (org.). Manejo da síndrome da abstinência e delirium em pediatria. 2. ed. Uberaba: Universidade Federal do Triângulo Mineiro, 2021a. 16 p. (Protocolos clínicos). Disponível em: https://www.gov.br/ebserh/pt-br/hospitais-universitarios/regiao-sudeste/hc-uftm/documentos/protocolos-assistenciais/62PRT.DM.007ManejodaSndromedaAbstinnciaeDeliriumemPediatriaverso2.pdf. Acesso em: 05 out. 2023.
GOPISETTI, Sharmila; PLAYFOR, Stephen D.. Sedation and analgesia for critically ill children. Paediatrics And Child Health, Ottawa, v. 29, n. 5, p. 224-229, maio 2019. Disponível em: http://dx.doi.org/10.1016/j.paed.2019.02.005. Acesso em: 13 fev. 2025.
HARRIS, Julia et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an espnic position statement for healthcare professionals. Intensive Care Medicine, [S.L.], v. 42, n. 6, p. 972-986, 15 abr. 2016. Disponível em: http://dx.doi.org/10.1007/s00134-016-4344-1. Acesso em: 13 fev. 2025.
KLEIN, Kassiely et al. Síndrome de abstinência pediátrica identificação, fatores de riscos e tratamento. Revista Recien - Revista Científica de Enfermagem, São Paulo, v. 11, n. 36, p. 54-64, 22 dez. 2021. Revista Recien - Revista Cientifica de Enfermagem. http://dx.doi.org/10.24276/rrecien2021.11.36.54-64. Disponível em: https://recien.com.br/index.php/Recien/article/view/491. Acesso em: 03 out. 2023.
NAVARRO, Concepción Míguez et al. Efficacy, safety and satisfaction of sedation-analgesia in Spanish emergency departments. Anales de Pediatría (English Edition), [S.L.], v. 90, n. 1, p. 32-41, jan. 2019. Elsevier BV. http://dx.doi.org/10.1016/j.anpede.2018.03.008.
PATEL, Dhawal et al. The use of esketamine sedation in the emergency department for manipulation of paediatric forearm fractures: a 5 year study. Injury, [S.L.], v. 52, n. 6, p. 1321-1330, jun. 2021. Elsevier BV. http://dx.doi.org/10.1016/j.injury.2020.12.033. Disponível em: https://www.injuryjournal.com/article/S0020-1383(20)31066-4/abstract. Acesso em: 13 fev. 2025.
PREFEITURA MUNICIPAL SÃO JOSÉ DO RIO PRETO. 4/2021: Sedoanalgesia com fármacos A2 agonistas. São José do Rio Preto, 2021. 2 p.
RAMALHO, Carlos Eduardo. et al. Sedation and analgesia for procedures in the pediatric emergency room. Jornal de pediatria, v. 93 Suppl 1, p. 2–18, 2017. Disponivel em: https://revistaseletronicas.pucrs.br/scientiamedica/article/view/10456/8187.
REBOLLAR, R. Eizaga et al. Dexmedetomidine and perioperative analgesia in children. Revista Española de Anestesiología y Reanimación, Madrid, v. 69, n. 8, p. 487-492, out. 2022. Elsevier BV. http://dx.doi.org/10.1016/j.redare.2022.08.003.
SANAVIA, Eva et al. Sedative and Analgesic Drug Rotation Protocol in Critically Ill Children With Prolonged Sedation: evaluation of implementation and efficacy to reduce withdrawal syndrome. Pediatric Critical Care Medicine, Des Plaines, v. 20, n. 12, p. 1111-1117, dez. 2019. Ovid Technologies (Wolters Kluwer Health). Disponível em: https://pubmed.ncbi.nlm.nih.gov/31261229/. Acesso em: 13 fev. 2025.
SECRETÁRIA MUNICIPAL DE SAÚDE DE JOINVILLE. SMS-JOINVILLE: Diretriz de tratamento farmacológico da dor nos pronto atendimentos. Joinville: 2018. 14 p.
TROMBETTA, Andrea et al. Combined intranasal fentanyl and dexmedetomidine plus inhaled nitrous oxide sedation in children needing myringotomy and ventilation tube insertion with a specific handheld device. International Journal Of Pediatric Otorhinolaryngology, [S.L.], v. 136, n. 1, p. 110-112, set. 2020. Elsevier BV. http://dx.doi.org/10.1016/j.ijporl.2020.110221. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0165587620303645?via%3Dihub. Acesso em: 13 fev. 2025.
