Groeneveld A, Inkson T
Can Nurse. 1992 Sep;88(8):28-31.
Our experience has shown ketamine to be a safe and effective method of providing pain relief during specific procedures in burned children. It renders high doses of narcotics unnecessary and offers children the benefit of general anesthesia without the requirement of endotracheal intubation and a trip to the operating room. The response of parents and staff to the use of ketamine has been positive. Parents often experience feelings of guilt following injury to a child and are eager to employ methods that reduce their child's pain. So far, no parent has refused the administration of ketamine; some have even asked that it be used during subsequent procedures on their child. With adequate pre-procedure teaching, parents are prepared for the possible occurrence of emergent reactions and can assist in reorienting the child during recovery. Staff have found that the stress of doing painful procedures on children is reduced when ketamine is used. The procedures tend to be quicker and the predicament of working on a screaming, agitated child is eliminated. At the same time, nursing staff have had to get used to the nystagmic gaze of the children and accept that these patients are truly anesthetized even though they might move and talk. Despite the success we and others have had with ketamine, several questions about its use in burn patients remain unanswered. The literature does not answer such questions as: Which nursing measures reduce the incidence of emergent reactions? How many ketamine anesthetics can safely be administered to one individual? How does the frequency of administration relate to tolerance in a burn patient? Are there detrimental effects of frequent or long-term use? Clearly, an understanding of these questions is necessary to determine the safe boundaries of ketamine use in burn patients. Ketamine is not a panacea for the problem of pain in burned children. But it is one means of managing procedural pain, which is, after all, a significant clinical factor in treatment and recovery.
我们的经验表明，氯胺酮是为烧伤儿童进行特定手术时提供疼痛缓解的一种安全有效的方法。它无需使用高剂量的麻醉药，让儿童受益于全身麻醉，而无需进行气管插管和前往手术室。家长和工作人员对氯胺酮的使用反应良好。孩子受伤后，家长常常会感到内疚，并渴望采用能减轻孩子疼痛的方法。到目前为止，没有一位家长拒绝使用氯胺酮；有些家长甚至要求在其孩子后续的手术中使用。通过充分的术前指导，家长为可能出现的紧急反应做好了准备，并能在孩子恢复期间协助使其恢复定向。工作人员发现，使用氯胺酮时，对儿童进行痛苦手术的压力会减轻。手术往往进行得更快，处理哭闹、烦躁不安儿童的困境也消除了。同时，护理人员不得不习惯儿童的眼球震颤凝视，并接受这些患者确实处于麻醉状态，尽管他们可能会动和说话。尽管我们和其他人在氯胺酮的使用上取得了成功，但关于其在烧伤患者中的使用仍有几个问题未得到解答。文献中并未回答以下问题：哪些护理措施可降低紧急反应的发生率？一个人安全使用氯胺酮麻醉的次数是多少？给药频率与烧伤患者的耐受性有何关系？频繁或长期使用是否有有害影响？显然，了解这些问题对于确定氯胺酮在烧伤患者中使用的安全界限是必要的。氯胺酮并非解决烧伤儿童疼痛问题的万灵药。但它是处理手术疼痛的一种手段，毕竟手术疼痛是治疗和恢复过程中的一个重要临床因素。
