Évaluation de la douleur lors de la pose de cathéters épicutanéocaves chez les nouveau-nés prématurés, proposition d’une nouvelle stratégie médicamenteuse pour l’analgésie en néonatologie : la kétamine per os

Abstract : Introduction: Recognition, assessment and appropriate management of pain in premature newborns are essential. Inserting epicutaneous catheters is one of many invasive procedures performed in neonatology. Methods: Observational study from August to December 2015 at the Bordeaux University Hospital. Main objective: Assess pain with the DAN scale and the NIPE monitor during epicutaneous catheters insertion in premature infants. The NIPE index evaluates parasympathetic activity analyzing the variability of heart rate. A newborn would be painful for a instant NIPE index (NIPEi) < 50. Another person quoted blindly the DAN and the NIPE index at the different events of the pose. The usual analgesia protocol use G30% and non-nutritive sucking. Secondary objectives: comparison NIPEi / DAN, identification of the most painful events. Results: 35 premature infants included, with a median term of 31.8 SA and a median weight of 1155 g. The NIPEi were < 50 , 37% of the time. NIPEi minimum and maximum DAN were 35 and 5.2 respectively. Forced maintaining member was the most painful event (NIPEi 45, DAN 4). DAN and NIPEi were well correlated with an area under the ROC curve at 0.92. Conclusion: Analgesia using G30% and non-nutritive sucking appears inadequate for epicutaneous catheters insertion. We must overcome this lack of analgesia by other treatment, probably pharmacological. Oral ketamine may be interesting, but its pharmacokinetics remains unknown among preterm infants. We imagines pharmacokinetic and pharmacodynamic studies of intravenous and oral ketamine in preterm infants to define the terms of administration. Then a randomized study could compare oral ketamine to the current protocol.
Document type :
Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01304337
Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Tuesday, April 19, 2016 - 4:08:22 PM
Last modification on : Wednesday, August 23, 2017 - 4:31:18 PM
Long-term archiving on : Tuesday, November 15, 2016 - 6:45:58 AM

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Barbara Ros. Évaluation de la douleur lors de la pose de cathéters épicutanéocaves chez les nouveau-nés prématurés, proposition d’une nouvelle stratégie médicamenteuse pour l’analgésie en néonatologie : la kétamine per os. Médecine humaine et pathologie. 2016. ⟨dumas-01304337⟩

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