Aprazamento seguro da terapia analgésica com opioides no paciente queimado: um estudo transversal [Safe opioid analgesic therapy dose scheduling for burn patients: a cross-sectional study]
DOI:
https://doi.org/10.12957/reuerj.2017.28082Keywords:
terapia intensiva, analgesia, insuficiência respiratória, segurança do pacienteAbstract
Objetivos: descrever a terapêutica dos opioides na analgesia de pacientes queimados e identificar interações medicamentosas no processo de aprazamento, contribuindo para a prevenção da depressão respiratória. Método: estudo retrospectivo, sendo analisados 272 prontuários de pacientes queimados, internados entre 2011 a 2013. Rastreados episódios de depressão respiratória pelos indicadores: administração de Naloxone, pressão arterial menor de 110/60mmHg, intubação orotraqueal, oximetria de pulso menor que 90%, frequência respiratória menor que 10 irpm, necessidade de oxigênio e interrupção abrupta do opioide. Resultados: predominou a analgesia com os opioides: tramadol (45,49%) e metadona (18,45%). Os horários de aprazamento predominantes foram 22h e 06h. Potenciais interações medicamentosas ocorreram em 66,6% dos casos, dos pares de medicamentos estudados, 88,8% podem causar com danos graves. Conclusão: ao aprazar os medicamentos prescritos, o enfermeiro deve atentar que o aprazamento indevido de opioide pode ocasionar interação medicamentosa, potencializando seu efeito farmacológico, com o risco de queda do nível de consciência. depressão respiratória.
ABSTRACT
Objectives: to describe opioid therapy in analgesia for burn patients, and to identify drug interactions in the scheduling process, thus contributing to prevention of respiratory depression. Methods: this retrospective study examined 272 medical records of burn patients hospitalized between 2011 and 2013. Naloxone administration, blood pressure lower than 110/60mmHg, orotracheal intubation, pulse oximetry less than 90%, respiratory rate less than 10 bpm, need for oxygen, and abrupt opioid discontinuation. Results: analgesia was predominantly with the opioids: tramadol (45.49%) and methadone (18.45%). Predominant administration times were 10pm and 6pm. There was potential for drug interactions in 66.6% of the cases, while 88.8% of the drug pairs studied can cause severe harm. Conclusion: when scheduling the prescribed medication, nurses should be aware that inappropriate opioid dose scheduling may lead to drug interaction, potentiating pharmacological effects, with the risk of loss of consciousness and respiratory depression.
RESUMEN
Objetivos: describir el tratamiento de los opioides en la analgesia de pacientes quemados e identificar interacciones medicamentosas en el proceso de programación, contribuyendo a la prevención de la depresión respiratoria. Método: estudio retrospectivo, que analizó 272 historias clínicas de pacientes quemados, hospitalizados entre 2011 y 2013. Los episodios de depresión respiratoria fueron rastreados a través de: administración de Naloxona, presión arterial inferior a 110 / 60mmHg, intubación orotraqueal, oximetría de pulso inferior al 90%, frecuencia respiratoria inferior a 10 latidos por minuto, necesidad de oxígeno e interrupción brusca del opioide. Resultados: los analgésicos opioides son los más utilizados, predominantemente tramadol (45.49%) y metadona (18,45%). Los horarios de programación predominantes fueron 22:00 y 06:00. Interacciones potenciales medicamentosas ocurrieron en el 66,6% de los casos, de los pares de medicamentos estudiados el 88,8% puede causar graves daños. Conclusión: al programar los medicamentos prescritos, el enfermero debe atentar que la programación indebida del opioide puede ocasionar interacción medicamentosa, potenciando su efecto farmacológico, corriendo el riesgo de caída del nivel de consciencia y depresión respiratoria.
DOI: http://dx.doi.org/10.12957/reuerj.2017.28082
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