Baxter Amy Lynn, Mallory Michael D, Spandorfer Philip R, Sharma Sujit, Freilich Steven H, Cravero Joseph
Pediatric Emergency Medicine Associates, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA.
Pediatr Emerg Care. 2007 Oct;23(10):690-5. doi: 10.1097/PEC.0b013e3181558d5c.
To compare efficacy, sedation duration, and adverse events after administration of etomidate or pentobarbital for diagnostic computed tomography (CT) scans.
A cohort of children sedated for CT scans between July 2004 and October 2005 was identified from a prospectively generated Pediatric Sedation Research Consortium database. The 24 Pediatric Sedation Research Consortium institutions prospectively record consecutive sedation data and adverse events on a Web-based tool. This study included all patients of American Society for Anesthesiologists (ASA) class I or II, between 6 months and 6 years old, sedated with etomidate or with intravenous pentobarbital with or without midazolam. Outcomes included sedation efficacy, duration (time from drug administration until cessation of monitoring), and complication rate.
Of 3397 pediatric sedations for CT scans, 2587 met age and ASA criteria. Etomidate was administered by pediatric emergency physicians as the sole sedative for 446 sedation service cases; pentobarbital with or without midazolam was used in 396 sedations by a variety of providers. Sedation was "not ideal" for 11 pentobarbital sedations and 1 etomidate sedation. Median etomidate dose was 0.33 mg/kg (intraquartile rank, 0.30-0.44 mg/kg); median pentobarbital dose was 4 mg/kg (intraquartile rank, 3.2-4.8 mg/kg). Mean etomidate sedation (34 minutes; 95% confidence interval [CI], 32-36 minutes) was shorter than pentobarbital (144 minutes; 95% CI, 139-150 minutes). Etomidate patients were younger (24 vs. 29 months), whereas pentobarbital patients were more often of ASA class II (52% vs. 34%), both P < 0.001. Adverse events were more common with pentobarbital (4.5% vs. 0.9%; relative risk, 3.38%; 95% CI, 1.28%-9.45%). One etomidate and 2 pentobarbital patients experienced apnea.
Etomidate as given by emergency physicians was more effective and efficient than pentobarbital, with rare adverse events.
比较依托咪酯或戊巴比妥用于诊断性计算机断层扫描（CT）时的疗效、镇静持续时间及不良事件。
从前瞻性建立的儿科镇静研究联盟数据库中确定2004年7月至2005年10月期间因CT扫描接受镇静的一组儿童。24个儿科镇静研究联盟机构使用基于网络的工具前瞻性记录连续的镇静数据和不良事件。本研究纳入了所有美国麻醉医师协会（ASA）分级为I或II级、年龄在6个月至6岁之间、使用依托咪酯或静脉注射戊巴比妥（加或不加咪达唑仑）进行镇静的患者。观察指标包括镇静效果、持续时间（从给药至停止监测的时间）及并发症发生率。
在3397例儿科CT扫描镇静病例中，2587例符合年龄和ASA标准。儿科急诊医师将依托咪酯作为唯一镇静剂用于446例镇静服务病例；多种医疗人员在396例镇静中使用了戊巴比妥（加或不加咪达唑仑）。11例戊巴比妥镇静和1例依托咪酯镇静的镇静效果“不理想”。依托咪酯的中位剂量为0.33mg/kg（四分位数间距，0.30 - 0.44mg/kg）；戊巴比妥的中位剂量为4mg/kg（四分位数间距，3.2 - 4.8mg/kg）。依托咪酯的平均镇静时间（34分钟；95%置信区间[CI]，32 - 36分钟）短于戊巴比妥（144分钟；95%CI，139 - 150分钟）。依托咪酯组患者年龄较小（24个月对29个月），而戊巴比妥组患者ASA分级为II级的比例更高（52%对34%），两者P均<0.001。戊巴比妥组的不良事件更常见（4.5%对0.9%；相对风险，3.38%；95%CI，1.28% - 9.45%）。1例依托咪酯和2例戊巴比妥患者出现呼吸暂停。
急诊医师使用的依托咪酯比戊巴比妥更有效且高效，不良事件罕见。
