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Nejběžněji používaná analgetika v perioperační péči. Může se dle zvyku oddělení lišit.:

1)Neopiátová analgetika systémově:
Paracetamol 

0,5- 1,0 gm/4-6h max.4g/den (při užívání nad 10dní se max.denní dávka sníží na2,5g )
10- 15 mg/kg      max 60 mg/kg/den… max 4 g/den  (děti nad 50kg váhy)
10- 15 mg/kg      max 60 mg/kg/den… max 3 g/den  (děti pod50 kg váhy)
10- 15 mg/kg      max 60 mg/kg/den… max 2 g/den  (děti pod33 kg váhy)
7,5mg/kg            max 30 mg/kg/den … max 1g/den  (děti pod 10 kg váhy)

cestapodání – iv. v infuzi, per os, per rectum
předávkování- terapie: výplach žaludku, carbo adsorbens, monitorace plazmatické hladiny paracetamolu

N-Acetylcystein
150mg/kgv G5% během 15 min inf
50mg/kgv G5% během 4 hodin inf
100mg/kgv G5% během 16 hodin inf
(per os 70 – 140 mg/kg 3x denně)
Hemodialyza,Hemoperfuze

Metamizol
0,5- 1,0 gm/6 h max 4 g/den
10- 15 mg/kg  max 4 g/den u dětí
podáníper os, i.m., iv.- v pomalé infuzi pro riziko poklesu TK.

Ibuprofen
0,4- 0,8 gm/8 h max 2400 mg/den
10mg/kg  max 35 mg/kg/den u dětí

Diclofenak
25- 75 mg á 12 h per os.,im. – max 150 mg/den
50mg v pomalé infuzi iv., poté kontinuálně 5 mg/h do max.denní dávky 150 mg
udětí nad 20kg indikován pouze při chronické juvenilní artritidě, 1 – 3mg/kg/den p.os.
ANP0,5 – 1,0 g á 4 – 6 h max 5g/den

2) Opiáty systémově:

lék                  dávka            trvání účinku   poločas     kont. dávka   kont. senz.1/2 po 4inf
Morfin          0,1-0,2 mg/kg     240 min   1 – 3h
Fentanyl       2,0-20  ug/kg      30 min     4 – 6 h      2 – 20ug/kg/h             260min!
Sufenta         0,2-2,0ug/kg      30 min      2 – 4 h     0,2 – 2,0ug/kg/h          30 min
Alfentanyl     5-15 ug/kg         15min      90 min                                                 10 min
Remifentanyl                            10min    15 – 30 min 0,2 – 0,5ug/kg/min       10 min
Petidin          0,5 – 1,0 mg/kg  6h
Piritramid       0,1- 0,2 mg/kg 8 h
Nalbufin         0,1- 0,2 mg/kg 4-6 h
Pentazocin    15 – 30mg         2-4 h

Trankvanalgezie:
Ketamin anestezie

1-5mg/kg  iv.  trvání účinku 10-15 min
5-10mg/kg im.
1-2mg/kg bolus iv. s následným kontinuál.podáním inf. 10-50 ug/kg/min
analgezie 0,25mg/kg iv.   0,5mg/kg im.   trvání účinku cca 30-40min
alternativně nasální, bukální podání
Ketamin 0,5 – 1 mg/kg iv. + Midazolam 0,15 mg/kg iv.
Ketamin 1-2 mg/kg  im.    + Midazolam 2-5 mg im.

4) Opiáty iv. – PCA (pacient control analgezie):
Morfin    max.15 mg/h  kont.         0,5 – 2,5 mg bolus PCA      lock out interval5-10 minut
Fentanyl max. 250ug/h kont.         50-100 ugbolus PCA          lock outinterval 3-10 minut
Sufenta  max. 40 ug/h  kont.         2,5 – 5 ug bolusPCA           lock outinterval 3-10 minut

5)Analgosedační směsi:
Dormicum20mg  +  Sufenta 100 ug  ad 50ml FR  …..   1-5 ml/h
Dormicum20mg  +  Morfin  20 mg  ad 50 ml FR   ……  1-5 ml/h
Rohypnol8 mg    +  Morfin 20 mg   ad  50mlFR    ……   1-3 ml/h
Propofol 200 mg  + Rapifen 2 mg  ad 24ml FR     ……  3-10 ml/h

6) Opiáty v subarachnoideální analgezii:
Morfin 0,1 – 0,3 mg intratekálně  á 12-24 h
fentanyl5 – 25 ug intratekálně
sufenta2 – 10 ug intratekálně

7) Opiáty v epidurální analgezii:
Morfin        1- 5  mg      cca 8-20h kont.p. 0,1 -0,5 mg/h
Fentanyl    25 – 150 ug  cca 2-4 h  25 – 100 ug/h
Sufenta     10 – 60 ug    cca 2-4 h  10 – 20  ;ug/h
Buprenorfin  150 ug      cca 8-20 h

8) Lokální anestetika v epidurální analgezii:
porodnictví:
Ma0,125% (0,065%) 20ml + sufenta 10 – 30  ug
ztéto směsi bolus 6ml..poté 4-6 ml/h kont do epidurál.katetru
max.dennídávka Ma 600mg trendem nízké koncentrace LA ve velkém objemu.
Naropin 0,2%  + sufenta 10 – 30 ug   6-8 ml/h kontinuálně do epi katetru
pooperačníchirurgie:
Morfin3mg + Marcain 0,5% 5ml  ad  15 ml objemu …..  bolusové podánído)
epidurál.katetruá 8 – 12 hodin

9) Lokální anestetika u periferních blokád vanalgezii:
koncentraceLA v roli analgetickí používají 0,125 – 0,5%. Vyšší koncentrace jsou spojeny sanestezií a motorickou blokádou.
Karotickáchirurgie, štítnice
hlubokákrční blokáda       7ml LA na segment
povrchovákrční blokáda    10 – 15 ml LA
ramenníkloub                   interskalenickýblok         k analgezii stačí20ml LA
proximálníhumerus          supraklavikulárníblok
paže                                  interskalenickýblok         30 ml LA
supraklavikulárníblok      20 ml LA
loket ,předloktí                 infraklavikulárníblok       25 – 30 ml LA
zápěstí,ruka                      axilárníblok                    7- 10 ml LA ke každému nervu
blokádyv oblasti lokte
thorakotomie                     paravertebrálníblok dle   5 ml LA/segment, možnost katetru
mezižeberníhoprostoru
břišníchirurgie                  paravertebrálníblok dle   5ml LA na segment, možnost katetru
mezižeberníhoprostoru
kyčelníkloub                     psoaskompartment nebo 30ml LA
3v 1 blok
kolenníkloub                    psoaskompartment nebo   25 – 30 ml LA
3v 1 spolu s n.ischiadicus
bérec                                 n.ischiadicusspolu s        15 – 20 ml LA
(kompartmentsy)              n.saphenus                      10ml LA
kotník,noha                      n.ischiadicusspolu s         15 – 20 ml LA
n.saphenus                       10 ml LA (často není nutný k analgezii)

10) Lokální anestetika v intrapleurálním podání manalgezie:
zavedení epidurálního katetru v přední axilární čáře, 5.mezižebří,
bolus Ma0,5% 15 – 20 ml  á 6-9h ……… nebo kontinuální podání 5 – 10 mlLA/ hod.

PŘÍKLADY PERIOPERAČNÍ ANALGEZIE U DĚTÍ:
premedikace- dormicum 0,2 mg/kg p.os.
morfin 0,2 mg/kg im.
perioperačně- sufenta 0,5 – 1,0 ug/ kg/ hod kont. iv.
pooperačně- paracetamol 10 – 15 / kg iv. á 6 h ,  ibuprofen 5 – 10 mg/ kg á 8 h iv.
tramal 1 – 2 mg/ kg iv. á 6 h
morfin 0,01 – 0,02 mg/ kg / hod kont.
sufenta 0,5 – 1,0 ug/kg / hod kont.

(pfo)

 

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