Borker Anupama, Ambulkar Indumati, Gopal R, Advani S H
Department of Medical and Pediatric Oncology, Asian Institute of Oncology, Mahim, Mumbai, India.
Indian Pediatr. 2006 Apr;43(4):309-14.
Children often require relief of pain and anxiety while undergoing diagnostic and therapeutic procedures. Procedural sedation and analgesia (PSA) is the safe and effective control of pain, anxiety and motion so as to allow a necessary procedure to be performed and to provide an appropriate degree of memory loss or decreased awareness.
To prospectively describe procedural sedation and analgesia as performed in the pediatric oncology unit and to report the success of sedation and the incidence of complications.
IV Midazolam and IV Ketamine were used for PSA in pediatric oncology patients undergoing painful procedures.
Between June 2004 and December 2004, 55 diagnostic and therapeutic procedures were performed using PSA in 16 children. There were 9 boys and 7 girls with a median age of 11 years. Twelve patients had hematolymphoid malignancies and 4 patients had solid tumors. The indication for PSA were bone marrow aspiration and or biopsy in 7 patients, therapeutic lumbar puncture in 43 patients, bone marrow aspiration and lumbar puncture in 4 patients and skin biopsy in 1 patient. All 55 procedures were successfully completed. Adverse events occurred in 15 (27%) episodes and included transient drop in oxygen saturation, vomiting, dizziness and disinhibition with crying spells. Average time to arousable state and full recovery was 22 minutes and 31 minutes respectively. None of the patients complained of post procedure pain nor recalled the procedure at the follow up visit.
Procedural sedation and analgesia using midazolam and ketamine is a safe and efficient method of limiting anxiety and procedure related pain and can be successfully administered by non-anaesthesiologists. The complication rate is low and can be easily managed.
儿童在接受诊断和治疗程序时常常需要缓解疼痛和焦虑。程序性镇静镇痛（PSA）是对疼痛、焦虑和动作的安全有效控制，以便能够进行必要的程序，并提供适当程度的记忆丧失或意识减退。
前瞻性描述儿科肿瘤科进行的程序性镇静镇痛，并报告镇静的成功率和并发症发生率。
静脉注射咪达唑仑和氯胺酮用于接受疼痛程序的儿科肿瘤患者的PSA。
在2004年6月至2004年12月期间，对16名儿童进行了55次使用PSA的诊断和治疗程序。有9名男孩和7名女孩，中位年龄为11岁。12名患者患有血液淋巴系统恶性肿瘤，4名患者患有实体瘤。PSA的适应证为7例患者进行骨髓穿刺和/或活检，43例患者进行治疗性腰椎穿刺，4例患者进行骨髓穿刺和腰椎穿刺，1例患者进行皮肤活检。所有55例程序均成功完成。15例（27%）出现不良事件，包括血氧饱和度短暂下降、呕吐、头晕和哭闹发作时的行为失控。达到可唤醒状态和完全恢复的平均时间分别为22分钟和31分钟。所有患者在术后均未抱怨疼痛，在随访时也未回忆起该程序。
使用咪达唑仑和氯胺酮进行程序性镇静镇痛是一种安全有效的减轻焦虑和与程序相关疼痛的方法，非麻醉医生也可成功实施。并发症发生率低，易于处理。
