Vardy J M, Dignon N, Mukherjee N, Sami D M, Balachandran G, Taylor S
Department of Emergency Medicine, Hairmyres Hospital, East Kilbride G75 8RG, UK.
Emerg Med J. 2008 Sep;25(9):579-82. doi: 10.1136/emj.2007.056200.
To examine the effectiveness and safety of the sedative agents used in the emergency department following the introduction of ketamine as an agent for procedural sedation
A 2-year prospective audit of sedation practice was undertaken. This specifically examined the rationale behind a doctor's choice of sedative agent, the depth of sedation achieved, adverse events and the time taken to regain full orientation.
210 patients were included of whom 85 (40%) were given ketamine, 107 (51%) midazolam and 18 (9%) propofol. The median time to full orientation was 25 min for ketamine, 30 min for midazolam and 10 min for propofol. Complications occurred in 15.9% of sedations overall (14.6% of those given ketamine, 15.8% given midazolam and 22.2% given propofol). Apnoea and hypoxia most often occurred with midazolam and propofol, while hypertension and hypertonicity were encountered more frequently with ketamine. In addition, 19.5% of patients given ketamine suffered the re-emergence phenomenon. The association between deep sedation with no response to pain and adverse events encountered with midazolam does not occur with ketamine.
Ketamine is both safe and effective and compares favourably with midazolam as an agent for procedural sedation in the emergency department. Although the re-emergence phenomenon occurred, no psychological sequelae were encountered after return to full orientation. Ketamine may be particularly useful in groups of patients at high risk of adverse effects with midazolam.
研究在急诊科将氯胺酮用作程序性镇静药物后，所使用的镇静剂的有效性和安全性。
对镇静实践进行了为期2年的前瞻性审计。具体研究了医生选择镇静剂的理由、达到的镇静深度、不良事件以及恢复完全清醒所需的时间。
纳入210例患者，其中85例（40%）使用氯胺酮，107例（51%）使用咪达唑仑，18例（9%）使用丙泊酚。氯胺酮组恢复完全清醒的中位时间为25分钟，咪达唑仑组为30分钟，丙泊酚组为10分钟。总体镇静中有15.9%发生并发症（氯胺酮组为14.6%，咪达唑仑组为15.8%，丙泊酚组为22.2%）。呼吸暂停和低氧血症最常发生于咪达唑仑和丙泊酚组，而氯胺酮组更常出现高血压和高张力。此外，使用氯胺酮的患者中有19.5%出现再苏醒现象。咪达唑仑导致的深度镇静且对疼痛无反应与不良事件之间的关联在氯胺酮组未出现。
氯胺酮安全有效，作为急诊科程序性镇静药物与咪达唑仑相比具有优势。虽然出现了再苏醒现象，但恢复完全清醒后未出现心理后遗症。氯胺酮对于使用咪达唑仑有不良反应高风险的患者群体可能特别有用。
