Miner James R, Biros Michelle, Krieg Susan, Johnson Christopher, Heegaard William, Plummer David
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN 55415, USA.
Acad Emerg Med. 2003 Sep;10(9):931-7. doi: 10.1111/j.1553-2712.2003.tb00646.x.
Although methohexital has been well studied for use in emergency department (ED) procedural sedation (PS), propofol has been evaluated less extensively for ED use.
The authors hypothesized that there is no difference in the depth of sedation and the rate of respiratory depression (RD) between propofol and methohexital in PS during the reduction of fractures and dislocations in the ED.
This was a randomized prospective study of nonintoxicated adult patients undergoing PS for fracture or dislocation reduction in the ED between July 2001 and March 2002. Patients were randomized to receive either propofol or methohexital, 1 mg/kg intravenously, followed by repeat boluses of 0.5 mg/kg every 2 minutes until adequate sedation was achieved. Doses, vital signs, end-tidal CO(2) (ETCO(2)) by nasal cannulae, pulse oximetry, and bispectral electroencephalogram analysis (BIS) scores were recorded. RD was defined as an ETCO(2) greater than 50 torr, an oxygen saturation less than 90% at any time, or an absent ETCO(2) waveform. After returning to baseline mental status, patients completed three 100-mm visual analog scales (VASs) regarding pain associated with the procedure, recall of the procedure, and satisfaction. RD rates and VAS outcomes were compared with chi-square tests.
There were 109 patients enrolled; six were excluded for study protocol violations. Of the remaining 103 patients, 52 received methohexital (reduction successful in 94%) and 51 received propofol (98% successful). No cardiac rhythm abnormalities or significant decline in systolic blood pressure (>20%) was detected. Six patients required bag-valve-mask-assisted ventilations during the procedure, all for less than 1 minute; four of these patients received methohexital, and two received propofol. By the authors' definition, RD was seen in 25 of 52 (48%) patients receiving methohexital and 25 of 51 (49%) patients receiving propofol (p = 0.88). The mean minimum recorded BIS score was 66.2 (95% confidence interval [CI] = 62 to 70) for methohexital and 66 (95% CI = 60 to 71) for propofol. VAS results showed similar rates of reported pain, recall, and satisfaction for the two agents.
The authors were unable to detect a significant difference in the level of subclinical RD or the level of sedation by BIS between the two agents. The use of either agent seems to be safe in the ED.
尽管甲己炔巴比妥用于急诊科（ED）程序性镇静（PS）已得到充分研究，但丙泊酚用于急诊科的评估相对较少。
作者推测，在急诊科对骨折和脱位进行复位时，丙泊酚和甲己炔巴比妥在PS中的镇静深度和呼吸抑制（RD）发生率无差异。
这是一项对2001年7月至2002年3月期间在急诊科因骨折或脱位复位而接受PS的未中毒成年患者进行的随机前瞻性研究。患者被随机分为接受丙泊酚或甲己炔巴比妥，静脉注射1mg/kg，随后每2分钟重复推注0.5mg/kg，直至达到充分镇静。记录剂量、生命体征、经鼻套管的呼气末二氧化碳（ETCO₂）、脉搏血氧饱和度和脑电双频指数分析（BIS）评分。RD定义为ETCO₂大于50托、任何时间血氧饱和度低于90%或ETCO₂波形消失。恢复到基线精神状态后，患者完成关于与该操作相关的疼痛、对该操作的回忆和满意度的三个100mm视觉模拟量表（VAS）。RD发生率和VAS结果采用卡方检验进行比较。
共纳入109例患者；6例因违反研究方案被排除。其余103例患者中，52例接受甲己炔巴比妥（复位成功94%），51例接受丙泊酚（98%成功）。未检测到心律失常或收缩压显著下降（>20%）。6例患者在操作过程中需要球囊面罩辅助通气，均持续不到1分钟；其中4例接受甲己炔巴比妥，2例接受丙泊酚。根据作者的定义，52例接受甲己炔巴比妥的患者中有25例（48%）出现RD，51例接受丙泊酚的患者中有25例（49%）出现RD（p = 0.88）。甲己炔巴比妥记录的平均最低BIS评分为66.2（95%置信区间[CI]=62至70），丙泊酚为66（95%CI = 60至71）。VAS结果显示，两种药物报告的疼痛、回忆和满意度发生率相似。
作者未能检测到两种药物在亚临床RD水平或BIS镇静水平上的显著差异。在急诊科使用这两种药物似乎都是安全的。
