儿科急诊科接受程序性镇静和镇痛的儿童的术前禁食状态与不良事件

Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department.

作者信息

Agrawal Dewesh, Manzi Shannon F, Gupta Raina, Krauss Baruch

机构信息

Division of Emergency Medicine, Children's Hospital Boston and Harvard Medical School, Boston, MA, USA.

出版信息

Ann Emerg Med. 2003 Nov;42(5):636-46. doi: 10.1016/s0196-0644(03)00516-x.

DOI:10.1016/s0196-0644(03)00516-x

PMID:14581915

Abstract

STUDY OBJECTIVE

Assessment of preprocedural fasting is considered essential in minimizing the risks of procedural sedation and analgesia. Established fasting guidelines are difficult to follow in the emergency department (ED). We characterize the fasting status of patients receiving procedural sedation and analgesia in a pediatric ED and assess the relationship between fasting status and adverse events.

METHODS

A prospective case series was conducted in a children's hospital ED during an 11-month period. All consecutive patients requiring procedural sedation and analgesia were included. Preprocedural fasting state and adverse events were recorded. The percentage of patients undergoing procedural sedation and analgesia who did not meet fasting guidelines was determined. Adverse events were analyzed in relation to fasting status.

RESULTS

One thousand fourteen patients underwent procedural sedation and analgesia, and data on fasting status were available for 905 (89%) patients. Of these 905 patients, 509 (56%; 95% confidence interval [CI] 53% to 60%) did not meet fasting guidelines. Seventy-seven adverse events occurred in 68 (6.7%; 95% CI 5.2% to 8.4%) of the 1,014 patients. All adverse events were minor and successfully treated. Adverse events occurred in 32 (8.1%; 95% CI 5.6% to 11.2%) of 396 patients who met and 35 (6.9%; 95% CI 4.8% to 9.4%) of 509 patients who did not meet fasting guidelines. There was no significant difference in median fasting duration between patients with and without adverse events and between patients with and without emesis. Emesis occurred in 15 (1.5%) patients. There were no episodes of aspiration (1-sided 97.5% CI 0% to 0.4%).

CONCLUSION

Fifty-six percent of children undergoing ED procedural sedation and analgesia were not fasted in accordance with established guidelines. There was no association between preprocedural fasting state and adverse events.

摘要

研究目的

术前禁食被认为对于将程序性镇静和镇痛的风险降至最低至关重要。既定的禁食指南在急诊科（ED）很难遵循。我们描述了一家儿科急诊科接受程序性镇静和镇痛患者的禁食状态，并评估禁食状态与不良事件之间的关系。

方法

在一家儿童医院急诊科进行了为期11个月的前瞻性病例系列研究。纳入所有连续需要程序性镇静和镇痛的患者。记录术前禁食状态和不良事件。确定未达到禁食指南的接受程序性镇静和镇痛患者的百分比。分析不良事件与禁食状态的关系。

结果

1014例患者接受了程序性镇静和镇痛，905例（89%）患者有禁食状态数据。在这905例患者中，509例（56%；95%置信区间[CI]53%至60%）未达到禁食指南。1014例患者中有68例（6.7%；95%CI5.2%至8.4%）发生了77起不良事件。所有不良事件均为轻微事件且得到成功治疗。符合禁食指南的396例患者中有32例（8.1%；95%CI5.6%至11.2%）发生不良事件，未达到禁食指南的509例患者中有35例（6.9%；95%CI4.8%至9.4%）发生不良事件。有不良事件和无不良事件的患者之间以及有呕吐和无呕吐的患者之间，禁食持续时间中位数无显著差异。15例（1.5%）患者发生呕吐。无吸入事件（单侧97.5%CI0%至0.4%）。