Karapinar Bülent, Yilmaz Deniz, Demirağ Kubilay, Kantar Mehmet
Pediatric Intensive Care Unit, Faculty of Medicine, Ege University, Izmir, Turkey.
Pediatr Int. 2006 Apr;48(2):146-51. doi: 10.1111/j.1442-200X.2006.02186.x.
Children often require relief of pain and anxiety when undergoing painful procedures. The purpose of this study is to evaluate the effectiveness and safety of painful pediatric procedures performed by pediatric intensivist, using the combination of intravenous ketamine and midazolam for sedation and analgesia.
The records of the patients who received intravenous ketamine-midazolam combination for painful procedures in the pediatric sedation unit of a university hospital over a 3 year period were retrospectively reviewed to determine indications, dosing, assessment of the level of sedation, adverse events, and recovery time for each procedural sedation and analgesia.
A total of 227 children aged 4 months to 18 years were admitted to the pediatric sedation unit for a total of 356 procedures. The indications for procedural sedation and analgesia included bone marrow aspiration or biopsy (50.8%), central venous catheter insertion (27%), and others (22%). A total of 46 adverse events (12.9%) were observed. These adverse events included SpO2 below 85% without apnea (n = 14), apnea (n = 3), transient stridor (n = 2), hypertension and tachycardia (n = 8), hypersalivation (n = 6), vomiting (n = 5), hallucinatory emergence reaction (n = 4), and rash (n = 4). There were no adverse outcomes attributable to ketamine and midazolam combination.
Skilled pediatric intensivists can safely and effectively administer ketamine and midazolam to facilitate painful procedures outside the operating room setting.
儿童在接受痛苦的医疗程序时常常需要缓解疼痛和焦虑。本研究的目的是评估儿科重症监护医师实施痛苦的儿科医疗程序时，使用静脉注射氯胺酮和咪达唑仑联合进行镇静和镇痛的有效性和安全性。
回顾性分析一所大学医院儿科镇静单元在3年期间接受静脉注射氯胺酮-咪达唑仑联合用于痛苦医疗程序的患者记录，以确定每次程序镇静和镇痛的适应症、剂量、镇静水平评估、不良事件及恢复时间。
共有227名年龄在4个月至18岁的儿童入住儿科镇静单元，共进行了356次医疗程序。程序镇静和镇痛的适应症包括骨髓穿刺或活检（50.8%）、中心静脉导管插入（27%）及其他（22%）。共观察到46例不良事件（12.9%）。这些不良事件包括无呼吸时SpO2低于85%（n = 14）、呼吸暂停（n = 3）、短暂性喘鸣（n = 2）、高血压和心动过速（n = 8）、流涎过多（n = 6）、呕吐（n = 5）、幻觉性苏醒反应（n = 4）及皮疹（n = 4）。没有因氯胺酮和咪达唑仑联合使用导致的不良后果。
技术熟练的儿科重症监护医师能够安全有效地给予氯胺酮和咪达唑仑，以促进在手术室以外环境中进行的痛苦医疗程序。
