Coll-Vinent Blanca, Sala Xavier, Fernández Carme, Bragulat Ernest, Espinosa Gerard, Miró Oscar, Millá José, Sánchez Miquel
Emergency Department, Hospital Clínic, Barcelona, Spain.
Ann Emerg Med. 2003 Dec;42(6):767-72. doi: 10.1016/s0196-0644(03)00510-9.
We compare effectiveness, adverse effects, and recovery times of propofol, etomidate, and midazolam (with and without flumazenil) for cardioversion in the emergency department (ED).
Thirty-two hemodynamically stable adult patients undergoing cardioversion in the ED were randomly assigned to receive etomidate (n=9), propofol (n=9), midazolam (n=8), or midazolam followed by flumazenil (n=6). For all patients, we measured induction time, awakening time, total recuperation time, global time, and adverse effects. Arterial pressure, cardiac and respiratory rate, and peripheral oxygen saturation were monitored throughout the procedure. Descriptive and nonparametric tests were used.
Demographic data were similar in all groups. Deep sedation and successful cardioversion were achieved in all cases. Hemodynamic assessment at baseline, after induction, after cardioversion, and at recovery demonstrated no significant difference between the 4 groups. Induction time was short in all groups. Awakening time was longer in the midazolam group (median 21 minutes, range 1 to 42 minutes) compared with that of the other groups (etomidate group: median 9.5 minutes, range 5 to 11 minutes; propofol group: median 8 minutes, range 3 to 15 minutes; midazolam/flumazenil group: median 3 minutes, range 2 to 5 minutes), and the same occurred with total recuperation time (etomidate group: median 14 minutes, range 5 to 20 minutes; propofol group: median 10 minutes, range 5 to 15 minutes; midazolam group: median 45 minutes, range 20 to 60 minutes; midazolam/flumazenil group: median 5 minutes, range 2 to 90 minutes). All patients in the midazolam/flumazenil group but 1 became resedated after flumazenil was discontinued. Four patients who had received etomidate exhibited myoclonus, which was pronounced and seizure-like in 1 case.
Four sedative regimens (propofol, etomidate, midazolam, and midazolam/flumazenil) were uniformly effective in facilitating ED cardioversion in hemodynamically stable adults. Propofol was well tolerated and lacked the myoclonus, prolonged sedation, and resedation noted with the latter 3 respective groups. Larger studies are needed to generalize these conclusions.
我们比较丙泊酚、依托咪酯和咪达唑仑（加或不加氟马西尼）在急诊科（ED）用于心脏复律时的有效性、不良反应及恢复时间。
32例在急诊科接受心脏复律且血流动力学稳定的成年患者被随机分配接受依托咪酯（n = 9）、丙泊酚（n = 9）、咪达唑仑（n = 8）或咪达唑仑后加氟马西尼（n = 6）治疗。对所有患者，我们测量诱导时间、苏醒时间、总恢复时间、全程时间及不良反应。在整个过程中监测动脉压、心率、呼吸频率及外周血氧饱和度。采用描述性和非参数检验。
所有组的人口统计学数据相似。所有病例均实现深度镇静及成功心脏复律。4组在基线、诱导后、心脏复律后及恢复时的血流动力学评估无显著差异。所有组的诱导时间均较短。咪达唑仑组的苏醒时间（中位数21分钟，范围1至42分钟）长于其他组（依托咪酯组：中位数9.5分钟，范围5至11分钟；丙泊酚组：中位数8分钟，范围3至15分钟；咪达唑仑/氟马西尼组：中位数3分钟，范围2至5分钟），总恢复时间情况相同（依托咪酯组：中位数14分钟，范围5至20分钟；丙泊酚组：中位数10分钟，范围5至15分钟；咪达唑仑组：中位数45分钟，范围20至60分钟；咪达唑仑/氟马西尼组：中位数5分钟，范围2至90分钟）。咪达唑仑/氟马西尼组除1例患者外，所有患者在停用氟马西尼后均再次出现镇静。4例接受依托咪酯治疗的患者出现肌阵挛，其中1例较为明显且类似癫痫发作。
四种镇静方案（丙泊酚、依托咪酯、咪达唑仑和咪达唑仑/氟马西尼）在促进血流动力学稳定的成年患者在急诊科进行心脏复律方面均有效。丙泊酚耐受性良好，且没有后三组各自出现的肌阵挛、镇静时间延长及再次镇静的情况。需要更大规模的研究来推广这些结论。
