Comportamento negativo no pós-operatório imediato de anestesia pediátrica

Abstract

Early postoperative negative behavior (e-PONB) is a behavioral and/or cognition change that includes emergence delirium, emergence agitation and postoperative pain. The incidence may be up to 80%, depending on how the diagnosis was made. The diagnosis is clinical and based on scales. There are several scales for diagnosis of emergence delirium and agitation. The only validated is the PAED (Pediatric Anesthesia Emergence Delirium). This scale evaluates 5 points, such as: degree of contact with the caregiver’s eyes, awareness of the environment, if the child’s actions are intentional, degree of consolation and agitation of the child. Risk factores include: pre-school age, anesthesia for ear, nose and throat surgery, anesthesia with sevoflurane or desflurane. Prevention mesures are very well indicated in this complication and can be made with midazolam (0.1 mg/kg) i.v. at the end of surgery; propofol (1-3 mg/kg) i.v. at the end of surgery; clonidine v.o. (4 mcg/kg) as preanesthetic medication; dexmedetomidine EV (0.2-1 mcg/kg) as preanesthetic medication or in the perioperative period; fentanyl (1-2.5 mcg/kg) in the perioperative period. Total intravenous anesthesia is also a preventive mesure for emergence delirium and agitation. Because it is a self-limited complication, the treatment is only indicated for a very agitated child with a risk of self-injuries and loss of vascular lines, drains or dress ings. Treatment includes midazolam, propofol, fentanyl or dexmedetomidine at the same doses.