Ruth W J, Burton J H, Bock A J
Department of Emergency Medicine, Maine Medical Center, Portland, ME 04102, USA.
Acad Emerg Med. 2001 Jan;8(1):13-8. doi: 10.1111/j.1553-2712.2001.tb00539.x.
To determine the safety and effectiveness of intravenous (IV) etomidate for the sedation of patients undergoing painful procedures in the emergency department (ED).
A two-part feasibility study for ED patients receiving IV etomidate for painful ED procedures was undertaken. In the initial phase, a retrospective series of patients receiving etomidate for ED procedural sedation was considered. This phase served as the basis for a descriptive, prospective feasibility study of consecutive ED patients. During the second phase, patients were evaluated for complications related to IV etomidate sedation or the procedure performed. Immediately following the procedure, the physician was asked to complete a data collection sheet documenting the patient's etomidate dose, the number of doses required to complete the procedure, the analgesic used, the complications of the procedure, and the patient's procedural recall.
Intravenous etomidate was administered to nine patients during the initial study phase and 51 during the prospective, descriptive phase. Indications for sedation included dislocation reduction (25), cardioversion (7), fracture reduction (20), abscess incision and drainage (4), foreign body removal (3), and chest thoracostomy (1). Physicians used 0.1-mg/kg IV bolus etomidate. A mean of 1.6 doses of etomidate was used to complete procedures (range 1-3 doses). Of the 60 patients in both study groups, 59 (98%) achieved adequate sedation by physician's assessment. Procedural success was documented for 56 patients (93%). There were 12 complications reported: oxygen desaturation below 90% (5), myoclonus (4), vomiting (1), pain with injection (1), and a brief bradycardic episode (1). No patient required assistance with ventilation or endotracheal intubation.
Intravenous etomidate can be administered safely and effectively to provide appropriate conscious sedation for short, painful ED procedures.
确定静脉注射依托咪酯用于急诊科（ED）接受疼痛性操作患者镇静的安全性和有效性。
开展一项针对在急诊科接受静脉注射依托咪酯进行疼痛性操作的患者的两部分可行性研究。在初始阶段，回顾性分析了一系列接受依托咪酯用于急诊科操作镇静的患者。此阶段作为对连续的急诊科患者进行描述性前瞻性可行性研究的基础。在第二阶段，评估患者与静脉注射依托咪酯镇静或所进行操作相关的并发症。操作结束后，立即要求医生填写一份数据收集表，记录患者的依托咪酯剂量、完成操作所需的剂量数、使用的镇痛药、操作的并发症以及患者对操作的回忆。
在初始研究阶段，9名患者接受了静脉注射依托咪酯，在前瞻性描述性阶段有51名患者接受。镇静的适应证包括脱位复位（25例）、心脏复律（7例）、骨折复位（20例）、脓肿切开引流（4例）、异物取出（3例）和胸腔闭式引流术（1例）。医生使用0.1mg/kg静脉推注依托咪酯。完成操作平均使用1.6剂依托咪酯（范围为1 - 3剂）。在两个研究组的60名患者中，59名（98%）经医生评估达到了充分镇静。记录了56名患者（93%）操作成功。报告了12例并发症：氧饱和度低于90%（5例）、肌阵挛（4例）、呕吐（1例）、注射时疼痛（1例）和短暂心动过缓发作（1例）。没有患者需要通气辅助或气管插管。
静脉注射依托咪酯可安全有效地用于为急诊科短时间疼痛性操作提供适当的清醒镇静。
