Twite Mark D, Friesen Robert H
Department of Anesthesiology, The Children's Hospital, University of Colorado Health Sciences Center, Denver, Colorado 80218, USA.
Curr Opin Anaesthesiol. 2005 Aug;18(4):442-6. doi: 10.1097/01.aco.0000168331.11853.03.
This review is a survey of the recent literature concerning issues and trends in the rapidly changing field of pediatric sedation.
Clinical guidelines for the safe provision of sedation to children continue to be developed and revised. Systems for providing sedation are evolving, and the most successful models emerging are those that involve a dedicated team, either mobile or stationary, of physicians and nurses. A variety of drugs is used, and potent drugs that were designed as anesthetics, such as propofol and ketamine, are being administered outside the operating room by anesthesiologists and non-anesthesiologists. The safety of this practice continues to be debated. The reported incidence of adverse events is different in various settings and systems; however, outcome data are difficult to compare because of differences in study design and outcome definition. There is agreement that sedation is a continuum, and evidence that the depth of sedation attained during procedural sedation in children is often consistent with general anesthesia. Capnography and processed electroencephalogram monitoring have been described in sedation studies, may enhance safety during pediatric sedation, and should be investigated further.
The evolution of systems, drugs, and monitors for the provision of pediatric sedation is continuing. An accurate assessment of safety and other outcomes will be enhanced through the establishment of multicenter collaborative databases.
本综述旨在对近期有关快速变化的儿科镇静领域的问题和趋势的文献进行调查。
针对儿童安全镇静的临床指南仍在不断制定和修订。镇静服务体系正在不断发展，目前最成功的模式是由医生和护士组成的专门团队提供服务，该团队可以是移动的，也可以是固定的。使用的药物种类繁多，一些原本设计用作麻醉剂的强效药物，如丙泊酚和氯胺酮，正由麻醉医生和非麻醉医生在手术室以外的地方使用。这种做法的安全性仍存在争议。不同环境和系统中报告的不良事件发生率有所不同；然而，由于研究设计和结果定义的差异，结果数据难以进行比较。人们一致认为镇静是一个连续过程，并且有证据表明儿童在操作过程中所达到的镇静深度通常与全身麻醉相当。在镇静研究中已经提到了二氧化碳图和处理后的脑电图监测，它们可能会提高儿科镇静的安全性，值得进一步研究。
儿科镇静的体系、药物和监测手段仍在不断发展。通过建立多中心协作数据库，将能更准确地评估安全性和其他结果。
