Roelofse J A, Shipton E A, de la Harpe C J, Blignaut R J
Department of Anesthesiology, Faculty of Dentistry, University of Stellenbosch.
Anesth Prog. 2004;51(4):114-21.
This article details a double-blind, randomized study evaluating the efficacy and safety of intranasal sufentanil and intranasal midazolam (S/M) when compared with intranasal ketamine and intranasal midazolam (K/M) for sedation and analgesia in pediatric patients undergoing dental surgery. Fifty healthy ASA status 1 children aged 5-7 years, weighing 15-20 kg, and having 6 or more teeth extracted, were randomly allocated to 2 groups of 25 patients each (n = 50). In the S/M group, 25 children received intranasal sufentanil 20 microg, and intranasal midazolam 0.3 mg/kg 20 minutes before the induction of anesthesia. In the K/M group, 25 children received intranasal ketamine 5 mg/kg and intranasal midazolam 0.3 mg/kg 20 minutes before the induction of anesthesia. Sevoflurane in nitrous oxide and oxygen was used for induction and maintenance of anesthesia. This study demonstrated the safety and efficacy of both methods with ease of administration, combined with a rapid onset of action. Both groups were equally sedated. A smooth mask induction of anesthesia was experienced in the majority of children. Effective postoperative analgesia for multiple dental extractions was provided. The intranasal administration of drugs for sedation and analgesia has some promising features in preschool children undergoing multiple dental extractions.
本文详细介绍了一项双盲随机研究，该研究评估了在接受牙科手术的儿科患者中，与鼻内给予氯胺酮和咪达唑仑（K/M）相比，鼻内给予舒芬太尼和咪达唑仑（S/M）用于镇静和镇痛的疗效和安全性。五十名健康的美国麻醉医师协会（ASA）1级儿童，年龄5至7岁，体重15至20千克，且要拔除6颗或更多牙齿，被随机分为2组，每组25名患者（n = 50）。在S/M组中，25名儿童在麻醉诱导前20分钟接受鼻内舒芬太尼20微克和鼻内咪达唑仑0.3毫克/千克。在K/M组中，25名儿童在麻醉诱导前20分钟接受鼻内氯胺酮5毫克/千克和鼻内咪达唑仑0.3毫克/千克。使用七氟醚、氧化亚氮和氧气进行麻醉诱导和维持。本研究证明了两种方法的安全性和有效性，给药简便，起效迅速。两组的镇静程度相同。大多数儿童都顺利地通过面罩进行了麻醉诱导。为多次拔牙提供了有效的术后镇痛。在接受多次拔牙的学龄前儿童中，鼻内给药用于镇静和镇痛具有一些有前景的特点。
