Acworth J P, Purdie D, Clark R C
Department of Emergency Medicine, Royal Children's Hospital, Herston, Brisbane, Australia.
Emerg Med J. 2001 Jan;18(1):39-45. doi: 10.1136/emj.18.1.39.
This study compared intranasal midazolam (INM) with a combination of intravenous ketamine and intravenous midazolam (IVKM) for sedation of children requiring minor procedures in the emergency department.
A single blinded randomised clinical trial was conducted in the emergency department of a major urban paediatric hospital. Subjects requiring sedation for minor procedures were randomised to receive either INM (0.4 mg/kg) or intravenous ketamine (1 mg/kg) plus intravenous midazolam (0.1 mg/kg). Physiological variables and two independent measures of sedation (Sedation Score and Visual Analogue Sedation Scale) were recorded before sedation and at regular intervals during the procedure and recovery period. Times to adequate level of sedation and to discharge were compared.
Fifty three patients were enrolled over a 10 month period. Sedation was sufficient to complete the procedures in all children receiving IVKM and in 24 of the 26 receiving INM. Onset of sedation was an average of 5.3 minutes quicker with IVKM than with INM (95%CI 3.2, 7.4 minutes, p<0.001). Children given INM were discharged an average of 19 minutes earlier than those given IVKM (95%CI 4, 33 minutes, p=0.02). Mean Sedation Scores and Visual Analogue Sedation Scale scores for the 30 minutes after drug administration were significantly better in children given IVKM compared with INM (2.4 and 1.8 versus 3.5 and 3.8, respectively). Both doctors and parents were more satisfied with sedation by intravenous ketamine and midazolam.
Intravenous ketamine plus midazolam used in an appropriate setting by experienced personnel provides an excellent means of achieving sedation suitable for most non-painful minor procedures for children in the emergency department. This combination is superior to INM in terms of speed of onset and consistency of effect. INM delivered via aerosol spray has a more variable effect but may still be adequate for the completion of many of these procedures.
本研究比较了鼻内咪达唑仑（INM）与静脉注射氯胺酮和静脉注射咪达唑仑联合使用（IVKM）对急诊科需要进行小手术的儿童的镇静效果。
在一家大型城市儿科医院的急诊科进行了一项单盲随机临床试验。需要进行小手术镇静的受试者被随机分为接受INM（0.4mg/kg）或静脉注射氯胺酮（1mg/kg）加静脉注射咪达唑仑（0.1mg/kg）。在镇静前以及手术和恢复期定期记录生理变量和两种独立的镇静测量指标（镇静评分和视觉模拟镇静量表）。比较达到充分镇静水平的时间和出院时间。
在10个月期间招募了53名患者。所有接受IVKM的儿童以及接受INM的26名儿童中的24名，镇静效果足以完成手术。IVKM的镇静起效平均比INM快5.3分钟（95%CI 3.2，7.4分钟，p<0.001）。接受INM的儿童比接受IVKM的儿童平均早出院19分钟（95%CI 4，33分钟，p=0.02）。与INM相比，接受IVKM的儿童给药后30分钟的平均镇静评分和视觉模拟镇静量表评分明显更好（分别为2.4和1.8，而INM为3.5和3.8）。医生和家长对静脉注射氯胺酮和咪达唑仑的镇静效果更满意。
经验丰富的人员在适当的情况下使用静脉注射氯胺酮加咪达唑仑是为急诊科儿童大多数无痛小手术实现镇静的极佳方法。这种联合用药在起效速度和效果一致性方面优于INM。通过气雾剂喷雾给药的INM效果更具变异性，但仍可能足以完成许多此类手术。
