Lightdale Jenifer R, Valim Clarissa, Newburg Adrienne R, Mahoney Lisa B, Zgleszewski Steven, Fox Victor L
Division of Gastroenterology, Children's Hospital Boston, Boston, Massachusetts 02115, USA.
Gastrointest Endosc. 2008 Jun;67(7):1067-75. doi: 10.1016/j.gie.2007.11.038. Epub 2008 Mar 26.
Many pediatric endoscopists are adopting propofol in their practices, with the expectation that propofol will increase their overall efficiency.
To compare the efficiency of propofol versus midazolam and fentanyl by measuring elapsed times between initial intravenous administration and patient discharge at a pediatric teaching hospital.
Endoscopy times were prospectively collected for consecutive patients who were undergoing either anesthesiologist-administered propofol or endoscopist-administered midazolam and fentanyl. The effect of the type of sedation on these times was assessed by using multiple linear regression by adjusting for other candidate predictors, including concomitant use of other sedatives, endotracheal intubation by anesthesiologists, and the presence of fellow trainees.
Time to onset of sedation (time sedation started to scope in), procedure time (endoscope in to endoscope out), discharge time (endoscope out to hospital discharge), and total time (sedation started to hospital discharge).
The times for 134 children (mean age 12 +/- 5 years) to receive propofol sedation were compared with those of 195 children (13 +/- 5 years) who received midazolam and fentanyl. Midazolam and fentanyl cases disproportionately included EGDs (P < .001) and patients who were classified as American Society of Anesthesiologists I (P < .03). Patients who received propofol had shorter times until sedated, similar procedure times, longer discharge times, and comparable total times. Multivariate analyses confirmed that fellow participation prolonged the procedure times (P < .0001), and endotracheal intubation prolonged propofol times (P <. 01), but adjusting for these did not change the comparison results.
Anesthesiologist-administered propofol sedation in a pediatric teaching endoscopy unit may not lead to faster hospital times when compared with endoscopist-administered midazolam and fentanyl. These results are not explained by controlling for patient characteristics, the presence of a trainee, the sedative doses, or endotracheal intubation for airway management.
许多儿科内镜医师在其临床实践中采用丙泊酚，期望丙泊酚能提高他们的整体效率。
在一家儿科教学医院，通过测量首次静脉给药至患者出院的时间，比较丙泊酚与咪达唑仑和芬太尼的效率。
前瞻性收集连续接受麻醉医师给予丙泊酚或内镜医师给予咪达唑仑和芬太尼的患者的内镜检查时间。通过多线性回归并调整其他候选预测因素（包括同时使用其他镇静剂、麻醉医师进行气管插管以及实习医生在场情况）来评估镇静类型对这些时间的影响。
镇静起效时间（镇静开始至内镜插入的时间）、操作时间（内镜插入至内镜拔出的时间）、出院时间（内镜拔出至出院的时间）以及总时间（镇静开始至出院的时间）。
将134名儿童（平均年龄12±5岁）接受丙泊酚镇静的时间与195名儿童（13±5岁）接受咪达唑仑和芬太尼镇静的时间进行比较。咪达唑仑和芬太尼组中接受上消化道内镜检查（EGD）的患者比例过高（P <.001），且被分类为美国麻醉医师协会I级的患者比例过高（P <.03）。接受丙泊酚镇静的患者镇静前等待时间较短，操作时间相似，出院时间较长，总时间相当。多变量分析证实实习医生参与会延长操作时间（P <.0001），气管插管会延长丙泊酚镇静时间（P <.01），但对这些因素进行调整后并未改变比较结果。
在儿科教学内镜检查单元，与内镜医师给予咪达唑仑和芬太尼相比，麻醉医师给予丙泊酚镇静可能不会使住院时间更快。控制患者特征、实习医生在场情况、镇静剂量或气道管理的气管插管等因素并不能解释这些结果。
