[Anesthetic procedure for balneotherapy of burned patients: prospective evaluation of 2852 cases.].
OBJECTIVE
Deep analgesia of burned patients needing daily care of their injuries is a field where references are very scarce in the literature. This study aimed at evaluating balneotherapy anesthetic technique in 2852 procedures.


METHODS
A one-year period prospective evaluation was performed on sedative and analgesic alternatives adopted by anesthesiologists. Age, weight, gender, burned surface area (BSA), drugs and doses used, duration, monitoring, number of sessions by patient, and complications were recorded. Samples was divided in four groups according to age: group A, < 10 years; group B, 11 to 17 years; group C, 18 to 65 years; group D, > 65 years, and the results were compared.


RESULTS
There have been 2852 balneotherapy sessions performed in 134 patients: Group A = 743 sessions in 42 patients; Group B = 354 sessions in 16 patients; Group C = 1573 sessions in 68 patients; Group D = 182 sessions in 8 patients. Throughout the study, the intravenous S(+)-ketamine as single agent was used in 116 sessions. The intravenous S(+)-ketamine with midazolam was used in 631 sessions. The intravenous S(+)-ketamine with midazolam and fentanyl was used in 1562 sessions. The muscular S(+)-ketamine as single agent was used in 188 sessions, being 173 in group A. The propofol was associated in 149 sessions. The racemic ketamine was used in 142 sessions. The alfentanil, as some other agents, was seldom used. Sessions lasted 29.3 +/- 10.6 minutes and the increased weight and/or BSA was correlated to significantly longer sessions. There have been 30 cases of SpO2 below 90%, being 3 cases (0.59%) in patients receiving intravenous S(+)-ketamine and midazolam, and 24 cases (1.93%) in patients receiving intravenous S(+)-ketamine, midazolam and fentanyl (p = 0.039). There has been one case of cardiac arrest in moribund patient, who was resuscitated and the session was completed.


CONCLUSIONS
The S(+)-ketamine, midazolam and fentanyl were the most common agents, being the S(+)-ketamine the major agent. Anesthetic techniques were safe and effective.
Cantinho
Fernando Antônio de Freitas
FA
Centro de Ensino e Treinamento, Hospital do Andaraí.
Santos
Fernando Guedes
FG
Silva
Antônio Carlos Pereira da
AC