Lucas da Silva Paulo Sérgio, Oliveira Iglesias Simone Brasil, Leão Flávia Vanesca Félix, Aguiar Vânia Euzébio, Brunow de Carvalho Werther
Pediatric Intensive Care Unit, Department of Pediatrics, Hospital do Servidor Público Municipal de São Paulo, São Paulo, Brazil.
Paediatr Anaesth. 2007 Apr;17(4):358-63. doi: 10.1111/j.1460-9592.2006.02099.x.
There is a lack of studies evaluating procedural sedation for insertion of central venous catheters (CVC) in pediatric patients in emergency departments or pediatric intensive care units (PICU). This study was designed to evaluate whether there is a difference in the total sedation time for CVC insertion in nonintubated children receiving two sedation regimens.
Patients were prospectively randomized to receive either midazolam/fentanyl (M/F) or midazolam/ketamine (M/K) i.v. The Children's Hospital of Wiscosin Sedation Scale was used to score the sedation level.
Fifty seven patients were studied (28 M/F and 29 M/K). Group M/F received midazolam (0.24 +/- 0.11 mg.kg(-1)) and fentanyl (1.68 +/- 0.83 microg.kg(-1)) and group M/K received midazolam (0.26 +/- 0.09 mg.kg(-1)) and ketamine (1.40 +/- 0.72 mg.kg(-1)). The groups were similar in age, weight, risk classification time and sedation level. Median total sedation times for M/F and M/K were 97 vs 105 min, respectively (P = 0.67). Minor complications occurred in 3.5% (M/F) vs 20.7% (M/K) (P = 0.03). M/F promoted a greater reduction in respiratory rate (P = 0.005).
In this study of nonventilated children in PICU undergoing central line placement, M/F and M/K provided a clinically comparable total sedation time. However, the M/K sedation regimen was associated with a higher rate of minor complications. A longer period of study is required to assess the efficacy and safety of these sedative agents for PICU procedures in nonintubated children.
在急诊科或儿科重症监护病房（PICU），缺乏针对儿科患者插入中心静脉导管（CVC）时进行程序镇静的研究。本研究旨在评估接受两种镇静方案的非插管儿童在插入CVC时的总镇静时间是否存在差异。
患者被前瞻性随机分为接受咪达唑仑/芬太尼（M/F）或咪达唑仑/氯胺酮（M/K）静脉注射。使用威斯康星儿童医院镇静量表对镇静水平进行评分。
共研究了57例患者（28例M/F和29例M/K）。M/F组接受咪达唑仑（0.24±0.11mg·kg⁻¹）和芬太尼（1.68±0.83μg·kg⁻¹），M/K组接受咪达唑仑（0.26±0.09mg·kg⁻¹）和氯胺酮（1.40±0.72mg·kg⁻¹）。两组在年龄、体重、风险分类时间和镇静水平方面相似。M/F组和M/K组的总镇静时间中位数分别为97分钟和105分钟（P = 0.67）。轻微并发症发生率在M/F组为3.5%，在M/K组为20.7%（P = 0.03）。M/F组导致呼吸频率下降幅度更大（P = 0.005）。
在本项针对PICU中接受中心静脉置管的未通气儿童的研究中，M/F和M/K的总镇静时间在临床上具有可比性。然而，M/K镇静方案的轻微并发症发生率较高。需要更长时间的研究来评估这些镇静剂在非插管儿童PICU操作中的疗效和安全性。
