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Master Thesis

Intérêt d’une sédation vigile par Rémifentanil pour la réalisation d’actes de soin douloureux en réanimation

Abstract : introduction: Procedural pain is frequent in intensive care unit. Our objective was to evaluate the feasibility and tolerance of a vigil sedation using Remifentanil target-controlled infusion (TCI), to perform procedures known to be painful in intensive care. Material and methods: this monocentric, prospective and observational study of routine care was conducted in patients requiring a potentially painful medical care procedure performed with vigil sedation. In accordance with the intensive care unit practices, Remifentanil TCI was used under close monitoring and adapted to the patient’s reactions. The main objective was the success of the procedure without additional analgesia. The secondary objectives were the clinical tolerance, the patient’s and the physician’s comfort during the act/performing the procedure. Results: from May 2014 to December 2015, 95 patients were included, 76% of them underwent fibreoptic bronchoscopy. The other procedures were digestive endoscopies (11%), thoracic drainage (10%), trans-oesophageal echocardiograms (5%), and pressure ulcers cares (2%). The main objective was achieved in 94% of the patients. No severe side effect were reported. The procedure was experienced as “comfortable or very comfortable” by 76% of the patients. On a visual analogical scale from 0 to 10, the median [IQR] comfort of the physician was rated 9 [8-10]. Conclusion: Remifentanil-TCI administered to perform potentially painful care procedures in the intensive care is feasible without rescue analgesics or sedative drugs and displays a safe clinical tolerance.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02483224
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Margot Caron. Intérêt d’une sédation vigile par Rémifentanil pour la réalisation d’actes de soin douloureux en réanimation. Médecine humaine et pathologie. 2018. ⟨dumas-02483224⟩

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