Rothermel Lori K
Department of Emergency Medicine, Geisinger Medical Center, 100 N. Academy Avenue, Danville, PA 17822-2005, USA.
Curr Opin Pediatr. 2003 Apr;15(2):200-3. doi: 10.1097/00008480-200304000-00011.
Procedural sedation for pediatric patients having painful or anxiety-producing procedures is a necessary but often a daunting task for emergency medicine providers. This article focuses on the two agents that have most recently been described for use in this population-etomidate and propofol. Etomidate is a nonbarbiturate sedative hypnotic agent with no analgesic properties. Its rapid onset of action, short duration of action, and minimal hemodynamic effects make it an attractive agent for use in procedural sedation. Similar to previous adult studies, recent studies have shown that etomidate is both safe and effective in this pediatric population. Propofol is also a sedative hypnotic agent with rapid onset and short duration of action. Typically, it is administered as a bolus injection followed by an infusion. It has long been used for surgical procedures as well as in the intensive care unit setting, but little literature has supported its use in the pediatric emergency department. Recent studies appear to support propofol's use in this setting; however, a significant rate of side effects, including hypoxia, apnea, and decreased blood pressure, may limit its use.
对于要接受疼痛性或引起焦虑的操作的儿科患者而言，实施程序性镇静对急诊医学从业者来说是一项必要但往往艰巨的任务。本文重点关注最近被描述用于该人群的两种药物——依托咪酯和丙泊酚。依托咪酯是一种无镇痛特性的非巴比妥类镇静催眠药。其起效迅速、作用时间短且对血流动力学影响极小，使其成为程序性镇静中一种有吸引力的药物。与先前的成人研究类似，近期研究表明依托咪酯在该儿科人群中既安全又有效。丙泊酚也是一种起效迅速、作用时间短的镇静催眠药。通常，它以静脉推注给药，随后进行输注。它长期用于外科手术以及重症监护病房，但很少有文献支持其在儿科急诊科的使用。近期研究似乎支持丙泊酚在此情况下的使用；然而，包括低氧血症、呼吸暂停和血压下降在内的显著副作用发生率可能会限制其使用。
