RESUMO

The goal of the present study was to propose the first local diagnostic reference levels (DRLs) for interventional pediatric cardiology procedures in a large hospital in Colombia. The data collection period was from April 2020 to July 2022. The local DRLs were calculated as the 3rd quartile of patient-dose distributions for the kerma-area product (Pka) values. The sample of collected clinical procedures (255) was divided into diagnostic and therapeutic procedures and grouped into five weight and five age bands. The Pka differences found between diagnostic and therapeutic procedures were statistically significant in all weight and age bands, except for the 1-5-year age group. The local DRLs for weight bands were 3.82 Gy·cm2 (<5 kg), 7.39 Gy·cm2 (5-<15 kg), 19.72 Gy·cm2 (15-<30 kg), 28.99 Gy·cm2 (30-<50 kg), and 81.71 Gy·cm2 (50-<80 kg), respectively. For age bands, the DRLs were 3.97 Gy·cm2 (<1 y), 9.94 Gy·cm2 (1-<5 y), 20.82 Gy·cm2 (5-<10 y), 58.00 Gy·cm2 (10-<16 y), and 31.56 Gy·cm2 (<16 y), respectively. In conclusion, when comparing our results with other existing DRL values, we found that they are similar to other centers and thus there is scope to continue optimizing the radiation dose values. This will contribute to establishing national DRLs for Colombia in the near future.

RESUMO

Resumen: Objetivo: Conocer si la ketamina a dosis subanestésicas disminuye el dolor agudo, agitación y requerimientos analgésicos en cateterismo cardíaco. Material y métodos: Pacientes de dos meses a siete años, anestesia general, ASA II-IV. Dos grupos: K: ketamina y F: fentanyl más analgésico; sevoflurano 1-1.2 CAM y ventilación mecánica. Registro de signos vitales: basales, inicio del procedimiento y emersión. Valoración con FLACC y Ramsay a la emersión y al llegar a su cama, se administró analgésico con FLACC > 4. Resultados: 121 pacientes, grupo K: 52.8%, grupo F: 47%, edad: 47 ± 26.38 meses, tiempo anestésico: 100.22 ± 38.7 min. Variables cardiovasculares sin diferencia intergrupos en relación al tiempo. Requerimientos analgésicos a las seis horas en grupo K y F hasta las 10 horas. FLACC en emersión leve 86.8%; 49% grupo K y 37% grupo F: (p = 0.02), al llegar a piso FLACC leve 92%, grupo K 52% y 40.4% grupo F (p = 0.002). A las seis horas FLACC > 4 en grupo K (p = 0.002). Grado de sedación a la extubación menor en el grupo K (p = 0.03). Conclusiones: La ketamina preserva estabilidad hemodinámica, disminuye agitación y dolor las primeras seis horas postprocedimiento; se puede utilizar como coadyuvante anestésico seguro.

Abstract: Objetive: Determine if the subanesthetic dose ketamine decreases acute pain, agitation, analgesic requirements in cardiac catheterization. Material and methods: Patients aged two months to seven years, general anesthesia, ASA II-IV. Two groups K: ketamine and F: fentanyl plus painkiller; sevoflurane 1-1.2 CAM and mechanical ventilation. Registration baseline vital signs, the initiation and emergence. FLACC and Ramsay evaluation in the emergence and reach bed, painkiller was administered FLACC > 4. Results: 121 patients, K group: 52.8%, group F: 47%, age: 47 ± 26.38 months, anesthetic time: 100.22 ± 38.7 min. Cardiovascular variables without intergroup difference in relation to time. Analgesia requirement at six hours in the K group vs F 10 hours. FLACC emergence mild to 86.8%; 49% K group and 37% F group (p = 0.02), 92% FLACC minor in bed, group K 52% and 40.4% F group (p = 0.002). At six hours FLACC > 4 K group (p = 0.002). Degree of sedation to extubation is lower in group K (p = 0.03). Conclusions: Ketamine preserves hemodynamic stability, decreases agitation and pain until the first six hours after procedure; so it can be used as adjuvant anesthetic in catheterizations safely.