Montes R G, Bohn R A
Division of Pediatric Gastroenterology, Phoenix Children's Hospital, Arizona 85006, USA.
J Pediatr Gastroenterol Nutr. 2000 Jul;31(1):41-6. doi: 10.1097/00005176-200007000-00010.
Sevoflurane is an inhaled anesthetic agent with ideal properties for achieving deep sedation during pediatric outpatient gastrointestinal endoscopy. This is a comparison of experience with this gas and other sedation methods used in the authors' hospital.
Retrospective chart review and statistical analysis of data from children receiving inhaled sevoflurane administered by an anesthesiologist through laryngeal insufflation, intravenous propofol, or intravenous midazolam-fentanyl-ketamine in any combination to achieve deep sedation for outpatient gastrointestinal endoscopy. Anesthesia was administered in a dedicated procedure room. The intravenous drugs were administered by pediatric intensivists in the intensive care unit. The same endoscopist performed all the procedures.
A total of 248 procedures were reviewed (midazolam-fentanyl-ketamine 67, propofol 114, and sevoflurane 67). All patients were adequately sedated with sevoflurane, and no intravenous access was required. Time (in minutes) to awakening (midazolam-fentanyl-ketamine 47.15, propofol 36.12, sevoflurane 5.70), discharge (midazolam-fentanyl-ketamine 141.99, propofol 91.20, sevoflurane 53.34), and total time, including induction and procedure (midazolam-fentanyl-ketamine 163.97, propofol 119.40, sevoflurane 73.93), were significantly lower for sevoflurane (P < 0.01). The complication rate for sevoflurane (4.5%) was lower (P < 0.05) than for midazolam-fentanyl-ketamine (13.4%) and for propofol (17.5%). Charges for room use and medications were also lower for sevoflurane (P < 0.01). The total charges for sedation (U.S.$) were comparable for sevoflurane (688.10) and propofol (723.08) but were higher for midazolam-fentanyl-ketamine (855.10, P < 0.01).
Deep sedation with inhaled sevoflurane for pediatric outpatient gastrointestinal endoscopy is as safe as conventional sedation techniques, potentially less expensive, increases endoscopy unit productivity, and eliminates the inconvenience associated with obtaining intravenous access in children.
七氟醚是一种吸入性麻醉剂，具有理想的特性，可用于小儿门诊胃肠内镜检查时实现深度镇静。本文比较了该气体与作者所在医院使用的其他镇静方法的经验。
回顾性查阅病历并对数据进行统计分析，这些数据来自接受麻醉医生通过喉内注入给予吸入性七氟醚、静脉注射丙泊酚或静脉注射咪达唑仑 - 芬太尼 - 氯胺酮（以任何组合）以实现门诊胃肠内镜检查深度镇静的儿童。麻醉在专用操作室进行。静脉药物由重症监护病房的儿科重症医生给药。所有操作均由同一位内镜医生进行。
共回顾了248例操作（咪达唑仑 - 芬太尼 - 氯胺酮组67例，丙泊酚组114例，七氟醚组67例）。所有患者使用七氟醚均能获得充分镇静，且无需静脉通路。苏醒时间（分钟）（咪达唑仑 - 芬太尼 - 氯胺酮组47.15，丙泊酚组36.12，七氟醚组5.70）、出院时间（咪达唑仑 - 芬太尼 - 氯胺酮组141.99，丙泊酚组91.20，七氟醚组53.34）以及包括诱导和操作在内的总时间（咪达唑仑 - 芬太尼 - 氯胺酮组163.97，丙泊酚组119.40，七氟醚组73.93），七氟醚组均显著更低（P < 0.01）。七氟醚的并发症发生率（4.5%）低于咪达唑仑 - 芬太尼 - 氯胺酮组（13.4%）和丙泊酚组（17.5%）（P < 0.05）。七氟醚的病房使用和药物费用也更低（P < 0.01）。镇静总费用（美元）七氟醚组（688.10）与丙泊酚组（723.08）相当，但高于咪达唑仑 - 芬太尼 - 氯胺酮组（855.10，P < 0.01）。
小儿门诊胃肠内镜检查使用吸入性七氟醚进行深度镇静与传统镇静技术一样安全，可能费用更低，可提高内镜检查科室的工作效率，并消除了儿童建立静脉通路带来的不便。
