RESUMO
Dexmedetomidine is an imidazole derivative, with high affinity for α2 adrenergic receptors, used for sedation, analgesia and adjuvant anaesthesia. In this study, an analytical method for the quantification of dexmedetomidine in dried blood spots was developed, validated and applied. The drug was extracted from dried blood spot by liquid extraction; the separation was carried out by ultra high-resolution liquid chromatography in reverse phase coupled to tandem mass spectrometry method. An X Select cyano 5 µm HSS column (2.1 X 150 mm, Waters) and a mobile phase composed of 0.1% formic acid: acetonitrile [50:50 v/v], were used. The test was linear over the concentration range of 50 to 2000 pg/mL. The coefficients of variation for the intra and interday trials were less than 15%. The drug was stable under the conditions tested. The method was successfully applied for the quantification of 6 patients, aged 0 to 2 years, with classification ASA I, who underwent ambulatory surgeries, receiving a dose of 1 µg/Kg dexmedetomidine IV. The drug concentrations in the different sampling times were in the range of 76 to 868 pg/mL.
Assuntos
Agonistas de Receptores Adrenérgicos alfa 2/sangue , Dexmedetomidina/sangue , Teste em Amostras de Sangue Seco/métodos , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/normas , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/sangue , Analgésicos não Narcóticos/normas , Pré-Escolar , Cromatografia Líquida de Alta Pressão/métodos , Dexmedetomidina/administração & dosagem , Dexmedetomidina/normas , Teste em Amostras de Sangue Seco/normas , Teste em Amostras de Sangue Seco/estatística & dados numéricos , Hematócrito , Humanos , Hipnóticos e Sedativos/administração & dosagem , Hipnóticos e Sedativos/sangue , Hipnóticos e Sedativos/normas , Lactente , Recém-Nascido , Padrões de Referência , Espectrometria de Massas em Tandem/métodosRESUMO
OBJECTIVE: Our aim was to describe the process of palliative sedation from the point of view of physicians and nurses working in palliative care in Brazil. METHOD: Ours was a descriptive study conducted between May and December of 2011, with purposeful snowball sampling of 32 physicians and 29 nurses working in facilities in Brazil that have adopted the practice of palliative care. RESULTS: The symptoms prioritized for an indication of palliative sedation were dyspnea, delirium, and pain. Some 65.6% of respondents believed that the survival time of a patient in the final phase was not a determining factor for the indication of this measure, and that the patient, family, and healthcare team should participate in the decision-making process. For 42.6% of these professionals, the opinion of the family was the main barrier to an indication of this therapy. SIGNIFICANCE OF RESULTS: The opinion of the physicians and nurses who participated in this study converged with the principal national and international guidelines on palliative sedation. However, even though it is a therapy that has been adopted in palliative care, it remains a controversial practice.
Assuntos
Atitude do Pessoal de Saúde , Sedação Profunda/normas , Hipnóticos e Sedativos/normas , Cuidados Paliativos/normas , Assistência Terminal/normas , Adulto , Brasil , Sedação Profunda/métodos , Delírio/tratamento farmacológico , Dispneia/tratamento farmacológico , Feminino , Humanos , Hipnóticos e Sedativos/administração & dosagem , Masculino , Manejo da Dor/métodos , Manejo da Dor/normas , Cuidados Paliativos/métodos , Assistência Terminal/métodosRESUMO
A great part of the patients in an Intensive Care Unit (ICU) need sedo-analgesia (SA), specially in mechanic ventilation (MV). Our unit is a general ICU where a diversity of therapeuticschemes and farmacological presentations have been used, without standard practices. At a first stage we introduced SA recommendations, reinforcing its use. We conducted the present study to evaluate its effect in our clinical practice. Methodology: Indicators of adverse incidents were registered, associated to MV, mortality, permanence in MV,hospitalization in ICU, use of medicines and cost, the results were measured during the 3 months prior to beginning and the 3 months following implementation of the SA recommendations, which ruled the use of the association of midazolam (MZ) (Dormonid (R), Laboratorio Roche (R) and morphine; in cases of the renal insufficiency, hemo-dynamic instability or allergic reaction it was chosen to associate MZ and fentanyl, both associations in continuous infusion and with suspension of morning sedation. The sedation level had to be evaluated with ramsay scale. Neurological patients were excluded. It was considered "strict compliance" when the recommended combination of medicines were utilized, adjusted by sedation scale and with matinal suspension; "partial compliance" when these were utilized without complying with the scale adjustement or the matinal suspension. The results obtained were analyzed utilizing the Primer(R) statistical program. Results: Before the introduction of the recommendations we observed an average MV duration of 5,8 days (Range: 1-82), duration of ICU hospitalization of 9,8 days (Range: 1-101), a mortality of 28 per cent, one case of auto-extubation, with the use of one average dose of MZ of 10±1,8 mg/hr, with a montly use of MZ in the unit of 22,2 g., a montly expense in sedatives, analgesics and relaxants of US$3018. After its introduction we observed an average duration at MV of 4,5 days (Range: 1-41) (NS), duration of hospitalization at ICU of 5,0 days (Range: 1-45) (p=0,001), a mortality of 22 per cent (NS), one case of auto-extubation, with an average dose of MZ of 4,2 g. (p=0,001), a montly expense in sedatives, analgesics and relaxants of US$809 (p=0,0001). Average compliance with the recommendations was 68 per cent (46 per cent partial, 22 per cent strict).