Guldner Gregory, Schultz Jason, Sexton Perry, Fortner Corwyn, Richmond Mark
Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
Acad Emerg Med. 2003 Feb;10(2):134-9. doi: 10.1111/j.1553-2712.2003.tb00030.x.
Physicians commonly use etomidate for adult rapid-sequence intubation (RSI), but the manufacturer does not recommend its use for children under 10 years of age due to a lack of data. The authors present their experience with etomidate for pediatric RSI in order to further develop its risk-benefit profile in this age group.
Trained abstractors reviewed the medical records for all children under 10 years old who received etomidate for RSI between July 1996 and April 2001.
105 children, with an average age of 3 (+/-2.9) years, received a median dose of 0.32 (+/-0.12) mg/kg of etomidate. The systolic blood pressure increased an average of 4 mm Hg (95% CI = -3.3 to 9.2); the diastolic blood pressure increased 7 mm Hg (95% CI = -3.1 to 11) within 10 minutes of receiving etomidate. The heart rate increased an average of 10 beats/min (95% CI = 4.0 to 17.4). Complications included three patients who vomited within 10 minutes of etomidate administration. There were no cases of documented myoclonus, status epilepticus, or new-onset seizures. Thirty-eight patients received corticosteroids during the hospital course, none for suspected adrenal insufficiency. Three patients died, all from severe brain injury.
In children less than 10 years old, etomidate seems to produce minimal hemodynamic changes, and appears to have a low risk of clinically important adrenal insufficiency, myoclonus, and status epilepticus. The association between etomidate and emesis (observed in less than 3% of enrolled patients) remains unclear. For clinical situations in which minimal blood pressure changes during RSI are critical, etomidate appears to have a favorable risk-benefit profile for children under 10 years old.
医生通常使用依托咪酯进行成人快速顺序诱导插管（RSI），但由于缺乏数据，制造商不建议将其用于10岁以下儿童。作者介绍了他们使用依托咪酯进行儿科RSI的经验，以便进一步明确其在该年龄组中的风险效益情况。
经过培训的摘要撰写人员查阅了1996年7月至2001年4月期间所有接受依托咪酯进行RSI的10岁以下儿童的病历。
105名儿童，平均年龄为3（±2.9）岁，接受的依托咪酯中位剂量为0.32（±0.12）mg/kg。在接受依托咪酯后10分钟内，收缩压平均升高4 mmHg（95%可信区间=-3.3至9.2）；舒张压升高7 mmHg（95%可信区间=-3.1至11）。心率平均增加10次/分钟（95%可信区间=4.0至17.4）。并发症包括3名患者在依托咪酯给药后10分钟内呕吐。没有记录到肌阵挛、癫痫持续状态或新发癫痫的病例。38名患者在住院期间接受了皮质类固醇治疗，均不是因为怀疑肾上腺功能不全。3名患者死亡，均死于严重脑损伤。
在10岁以下儿童中，依托咪酯似乎产生最小的血流动力学变化，并且临床上重要的肾上腺功能不全、肌阵挛和癫痫持续状态的风险似乎较低。依托咪酯与呕吐之间的关联（在不到3%的入组患者中观察到）仍不清楚。对于RSI期间血压变化最小至关重要的临床情况，依托咪酯对于10岁以下儿童似乎具有良好的风险效益情况。
