Gestion de l’analgésie multimodale incluant la kétamine au cours des manifestations vaso-occlusives graves des patients adultes drépanocytaires admis en réanimation : étude observationnelle

Abstract : Introduction: pain management is a major issue of the vaso-occlusive crisis (VOC) and acute chest syndrome (ACS) treatment in patients with sickle cell disease. Ketamine is commonly used in Intensive Care Unit (ICU) as an anti-hyperalgesic to prevent the phenomenon of tolerance to opioids. Nevertheless it has never been evaluated in pains related to sickle cell disease. The aim of this study was to describe medical practices in ICU for the management of VOC and ACS in patients with sickle cell disease. Methods: this prospective observational monocentric study included, during a 6 months period, adults admitted in intensive unit care for a VOC or a ACS. Results: 21 patients with a median age of 29 years [24 - 31] were included. Most of the patients had an intense pain: median VAS at 7 [5 - 9], median bone pain scale at 7 [3 - 9] in spite of the use of opioids. Ketamine was administered to 13 patients (76%) on the day they were admitted in ICU and to 17 patients during their ICU stay. The mean dosage of ketamine was 0,06 ± 0,02 mg/Kg/h for a median duration of 3 days [3 - 4]. On the fourth day, only one patient (5%) still hospitalized in ICU had an intense pain. opioids dosages stayed at moderate level with a dose/body weight per day always under 1 mg/Kg/J (0,60 mg/Kg/J ± 0,26). Neuropathic pains were few since only one patient had a DN4 score above and received Gabapentin as a specific treatment. Vital capacity increased by 700 mL [350 - 825] between ICU admission and discharge. There were no neuropsychiatric side effects (agitation, hallucination…) registered. Conclusion: in patients with sickle cell disease admitted in intensive care for VOC or ACS, analgesia achieved by ketamine and morphine combination is safe and efficient.
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Master Thesis
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Submitted on : Thursday, October 26, 2017 - 6:50:11 PM
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Louis Poujol de Molliens. Gestion de l’analgésie multimodale incluant la kétamine au cours des manifestations vaso-occlusives graves des patients adultes drépanocytaires admis en réanimation : étude observationnelle. Médecine humaine et pathologie. 2017. ⟨dumas-01624850⟩

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