Di Liddo Lydia, D'Angelo Antonio, Nguyen Bao, Bailey Benoit, Amre Devendra, Stanciu Constantin
Division of Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Ste-Justine, Montréal, Quebec, Canada.
Ann Emerg Med. 2006 Oct;48(4):433-40, 440.e1. doi: 10.1016/j.annemergmed.2006.03.004. Epub 2006 Apr 27.
Midazolam is widely used for procedural sedation and analgesia. Etomidate has been studied mostly in adults. Our objective is to compare the efficacy of etomidate and midazolam for achieving procedural sedation and analgesia in children.
A randomized, double-blind, emergency department and orthopedic clinic-based trial was carried out among patients aged 2 to 18 years with displaced extremity fractures. Patients were administered 1 microg/kg of fentanyl and either 0.2 mg/kg of etomidate or 0.1 mg/kg of midazolam. Adequate sedation was defined, for the purpose of this study, as a score of 4 or more on the Ramsay Sedation Scale. The primary outcome was induction and recovery time. The rates of adverse events, success of fracture reduction, and parent and physician satisfaction were also compared.
From April to August 2004, 100 of 128 eligible patients were enrolled (age 8.7+/-3.7 years; 50% male patients). A higher proportion of patients attained adequate sedation among those who received etomidate: 46 of 50 (92%) versus 18 of 50 (36%) (delta 56%; 95% confidence interval [CI] 38% to 69%). Time taken for induction (hazard ratio 4.9; 95% CI 2.2 to 10.9) and time taken for recovery (hazard ratio 2.8; 95% CI 1.5 to 5.1) were lower among patients who received etomidate. The rates of adverse events were similar in both groups, except for myoclonus and pain at the injection site, which was more frequent in the etomidate group.
Induction and recovery times are shorter with etomidate compared with midazolam. At the dosages used for procedural sedation and analgesia among children with displaced extremity fracture, etomidate has higher efficacy in comparison with midazolam.
咪达唑仑广泛用于程序性镇静和镇痛。依托咪酯大多在成人中进行研究。我们的目的是比较依托咪酯和咪达唑仑在儿童中实现程序性镇静和镇痛的疗效。
在2至18岁患有四肢骨折移位的患者中进行了一项基于急诊科和骨科诊所的随机双盲试验。患者接受1微克/千克的芬太尼以及0.2毫克/千克的依托咪酯或0.1毫克/千克的咪达唑仑。为本研究目的，充分镇静定义为Ramsay镇静量表评分4分或更高。主要结局是诱导和恢复时间。还比较了不良事件发生率、骨折复位成功率以及家长和医生的满意度。
2004年4月至8月，128名符合条件的患者中有100名入组（年龄8.7±3.7岁；50%为男性患者）。接受依托咪酯的患者中达到充分镇静的比例更高：50名中的46名（92%）对比50名中的18名（36%）（差值56%；95%置信区间[CI]38%至69%）。接受依托咪酯的患者诱导时间（风险比4.9；95%CI2.2至10.9）和恢复时间（风险比2.8；95%CI1.5至5.1）更低。两组不良事件发生率相似，但肌阵挛和注射部位疼痛在依托咪酯组更常见。
与咪达唑仑相比，依托咪酯的诱导和恢复时间更短。在用于四肢骨折移位儿童的程序性镇静和镇痛剂量下，依托咪酯比咪达唑仑具有更高的疗效。
