Pershad Jay, Gilmore Barry
Division of Emergency Services, Department of Pediatrics, University of Tennessee Health Sciences Center, Le Bonheur Children's Medical Center, Memphis, Tennessee, USA.
Pediatrics. 2006 Mar;117(3):e413-22. doi: 10.1542/peds.2005-1385.
As the number of diagnostic imaging studies performed has increased, the demand for sedation in support of these radiologic tests has also increased. Our objectives were to (1) assess the safety and efficacy of a radiology sedation service that is staffed exclusively by pediatric emergency medicine (PEM) physicians, (2) determine the frequency and the type of commonly performed pediatric imaging studies that require procedural sedation, and (3) assess the average duration of procedural sedation for commonly performed radiologic studies.
We conducted a retrospective observational study of patient encounters in 2004 involving procedural sedation to facilitate diagnostic imaging. We are a university-affiliated group of PEM physicians that provide a radiology sedation service during weekdays at a freestanding urban children's hospital.
The sedation service participated in 1285 patient encounters during the study period. Deep sedation was provided to 1027 patients. Moderate sedation was administered to 258 patients. Procedural sedation times for the most frequently performed imaging studies ranged from 5 to 183 minutes. Agents that were used to provide deep sedation were pentobarbital (with midazolam, fentanyl, or both) in 65% of cases, propofol in 31%, and ketamine (with or without midazolam) in 4%. Moderate sedation was achieved with chloral hydrate in 86% and oral diazepam in 14% of the cases. A total of 99.1% of the imaging studies were completed successfully. Six imaging studies were aborted because of failed sedation or occurrence of adverse event. Five patients who were deemed high risk on their presedation evaluation were referred electively for general anesthesia.
Our data suggest that a dedicated sedation team in support of diagnostic imaging services, staffed exclusively by PEM physicians, can be a successful clinical enterprise. The service consumes significant resources and physician time.
随着诊断性影像学检查数量的增加，支持这些放射学检查的镇静需求也在上升。我们的目标是：（1）评估由儿科急诊医学（PEM）医生专门配备人员的放射科镇静服务的安全性和有效性；（2）确定需要程序性镇静的常见儿科影像学检查的频率和类型；（3）评估常见放射学检查的程序性镇静平均时长。
我们对2004年涉及程序性镇静以辅助诊断性影像学检查的患者诊疗情况进行了一项回顾性观察研究。我们是一组隶属于大学的PEM医生，在工作日于一家独立的城市儿童医院提供放射科镇静服务。
在研究期间，镇静服务参与了1285例患者诊疗。1027例患者接受了深度镇静。258例患者接受了中度镇静。最常进行的影像学检查的程序性镇静时间为5至183分钟。用于深度镇静的药物中，65%的病例使用了戊巴比妥（与咪达唑仑、芬太尼或两者联用），31%使用了丙泊酚，4%使用了氯胺酮（联用或未联用咪达唑仑）。86%的病例使用水合氯醛实现中度镇静，14%使用口服地西泮。总共99.1%的影像学检查成功完成。6项影像学检查因镇静失败或发生不良事件而中止。5例在镇静前评估被视为高风险的患者被择期转诊接受全身麻醉。
我们的数据表明，由PEM医生专门配备人员、支持诊断性影像学服务的专用镇静团队可以成为一个成功的临床业务。该服务消耗大量资源和医生时间。
