Dickinson R, Singer A J, Carrion W
Department of Emergency Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.
Acad Emerg Med. 2001 Jan;8(1):74-7. doi: 10.1111/j.1553-2712.2001.tb00558.x.
While etomidate is reported as a procedural sedative in adults, its use in children has not been extensively reported. The authors describe their experience with etomidate for procedural sedation in children with extremity fractures and major joint dislocations.
This was a retrospective descriptive chart review. The setting was a university-based emergency department (ED) that follows national guidelines for procedural sedation. Subjects were children less than 18 years old who received etomidate prior to fracture reduction or major joint dislocations. Standardized data were abstracted from the medical records, including patient demographics, diagnosis, weight, types and doses of sedative and analgesic agents used, number of boluses of etomidate, attempts at reduction, complications encountered, vitals signs before, during, and after the reduction, disposition, and the time from procedure to discharge. Descriptive statistics calculated included means and proportions with 95% confidence intervals.
Fifty-three children received etomidate for fracture reduction. Their mean age was 9.7; 41.5% were females. Indications for reduction included forearm fractures (38), ankle fractures (12), upper arm fractures (2), and hip dislocations (1). In most cases (83%) reduction was successful after one attempt only. The mean initial and total doses of etomidate were 0.20 mg/kg (range, 0.1 to 0.4) and 0.24 mg/kg (range, 0.13 to 0.52), respectively. Thirteen patients required a second bolus of etomidate or midazolam. Thirty-four patients (64%) were discharged from the ED after a mean observation of 94 minutes (range, 35 to 255). There were no major adverse events (95% CI = 0% to 5.7%). One patient reported nausea and one required a fluid bolus for hypotension. One patient receiving multiple sedatives and opioid analgesics was admitted for observation due to prolonged sedation. No patient required assisted ventilation or intubation.
These results suggest that etomidate is a safe and effective agent for procedural sedation in children requiring fracture and major joint reductions.
虽然依托咪酯在成人中被用作操作时的镇静剂，但其在儿童中的使用尚未得到广泛报道。作者描述了他们在使用依托咪酯对患有四肢骨折和大关节脱位的儿童进行操作镇静时的经验。
这是一项回顾性描述性病历审查。研究地点是一家遵循国家操作镇静指南的大学急诊科。研究对象为18岁以下在骨折复位或大关节脱位前接受依托咪酯治疗的儿童。从病历中提取标准化数据，包括患者人口统计学信息、诊断、体重、使用的镇静剂和镇痛剂的类型及剂量、依托咪酯推注次数、复位尝试次数、遇到的并发症、复位前、复位期间和复位后的生命体征、处置情况以及从操作到出院的时间。计算的描述性统计数据包括均值和比例以及95%置信区间。
53名儿童接受依托咪酯进行骨折复位。他们的平均年龄为9.7岁；41.5%为女性。复位指征包括前臂骨折（38例）、踝关节骨折（12例）、上臂骨折（2例）和髋关节脱位（1例）。在大多数情况下（83%），仅一次尝试后复位即成功。依托咪酯的平均初始剂量和总剂量分别为0.20mg/kg（范围为0.1至0.4）和0.24mg/kg（范围为0.13至0.52）。13名患者需要第二次推注依托咪酯或咪达唑仑。34名患者（64%）在平均观察94分钟（范围为35至255分钟）后从急诊科出院。没有重大不良事件（95%置信区间 = 0%至5.7%）。1名患者报告恶心，1名患者因低血压需要静脉补液。1名接受多种镇静剂和阿片类镇痛药的患者因镇静时间延长而入院观察。没有患者需要辅助通气或插管。
这些结果表明，依托咪酯对于需要进行骨折和大关节复位的儿童操作镇静是一种安全有效的药物。
