Filatov S M, Baer G A, Rorarius M G, Oikkonen M
Department of Anaesthesiology, Tampere University Hospital and Medical School, Finland.
Acta Anaesthesiol Scand. 2000 Jan;44(1):118-24. doi: 10.1034/j.1399-6576.2000.440121.x.
Because of its pain-attenuating and sedative properties oral ketamine has been used as premedication in children and adults. We wanted to compare in children scheduled for adenoidectomy safety and efficacy of oral ketamine with a premedication that causes similar preoperative sedation and relief of pain at the venepuncture site. We also evaluated the effect of i.v. glycopyrrolate added to these combinations.
One hundred children between 10 and 15 kg of body weight scheduled for day-case adenoidectomy were randomly assigned to one of four groups: groups DG and DS received diclofenac 12.5 mg and diazepam 0.5 mg/kg rectally, EMLA cream at the venepuncture site, and placebo orally; groups KG and KS received ketamine 6.0 mg/kg orally, placebo cream at the puncture site, and placebo rectally; additionally, groups DG and KG received glycopyrrolate 5 microg/kg, and groups DS and KS received placebo intravenously. We recorded perioperatively scores (open scale 1-9) for stridor, sedation, bleeding, nausea, pain, heart rate, the need for analgesics and registered psychotomimesis and well-being at home.
The children of the K-groups became more tearful during separation from their parents (P=0.0072). No other differences were found between the ketamine and diazepam/diclofenac groups before and after premedication until induction of anaesthesia. Oral ketamine produced unpleasant psychotomimesis in four out of 59 children. During the first 10 min postoperatively, the score for stridor was significantly higher in group KS than in the D-groups; stridor scores > or = 6 were seen in one child of the D-groups (DS) and in six children of the K-groups (n.s.), of whom three developed laryngospasm (one reintubation). Glycopyrrolate diminished salivation in all groups, but had no effect on stridor scores. Additionally, glycopyrrolate delayed the onset of eating at home.
Premedication with racemic oral ketamine 6 mg/kg does not seem to be suitable for upper airway procedures. Addition of i.v. glycopyrrolate before the induction of anaesthesia significantly reduced the scores for salivation.
由于具有镇痛和镇静特性，口服氯胺酮已被用作儿童和成人的术前用药。我们想比较口服氯胺酮与能在术前产生类似镇静效果并减轻静脉穿刺部位疼痛的术前用药在计划行腺样体切除术的儿童中的安全性和有效性。我们还评估了静脉注射格隆溴铵添加到这些组合中的效果。
100名体重在10至15千克、计划行日间腺样体切除术的儿童被随机分配到四组中的一组：DG组和DS组直肠给予双氯芬酸12.5毫克和地西泮0.5毫克/千克，静脉穿刺部位涂抹EMLA乳膏，并口服安慰剂；KG组和KS组口服氯胺酮6.0毫克/千克，穿刺部位涂抹安慰剂乳膏，并直肠给予安慰剂；此外，DG组和KG组静脉注射格隆溴铵5微克/千克，DS组和KS组静脉注射安慰剂。我们记录了围手术期喘鸣、镇静、出血、恶心、疼痛、心率、镇痛药需求的评分（开放量表1 - 9），并记录了精神模仿症状和在家中的舒适度。
K组儿童在与父母分离时变得更加爱哭（P = 0.0072）。在术前用药直至麻醉诱导前，氯胺酮组和地西泮/双氯芬酸组之间未发现其他差异。59名儿童中有4名口服氯胺酮后出现不愉快的精神模仿症状。术后前10分钟内，KS组的喘鸣评分显著高于D组；D组（DS）有1名儿童和K组有6名儿童的喘鸣评分≥6（无统计学差异），其中3名发生喉痉挛（1名再次插管）。格隆溴铵减少了所有组的唾液分泌，但对喘鸣评分无影响。此外，格隆溴铵延迟了在家进食的开始时间。
6毫克/千克消旋口服氯胺酮作为术前用药似乎不适用于上呼吸道手术。麻醉诱导前静脉注射格隆溴铵显著降低了唾液分泌评分。
