Green Steven M, Roback Mark G, Krauss Baruch, Brown Lance, McGlone Ray G, Agrawal Dewesh, McKee Michele, Weiss Markus, Pitetti Raymond D, Hostetler Mark A, Wathen Joe E, Treston Greg, Garcia Pena Barbara M, Gerber Andreas C, Losek Joseph D
Department of Emergency Medicine, Loma Linda University Medical Center and Children's Hospital, Loma Linda, CA, USA.
Ann Emerg Med. 2009 Aug;54(2):158-68.e1-4. doi: 10.1016/j.annemergmed.2008.12.011. Epub 2009 Feb 7.
Although ketamine is one of the most commonly used sedatives to facilitate painful procedures for children in the emergency department (ED), existing studies have not been large enough to identify clinical factors that are predictive of uncommon airway and respiratory adverse events.
We pooled individual-patient data from 32 ED studies and performed multiple logistic regressions to determine which clinical variables would predict airway and respiratory adverse events.
In 8,282 pediatric ketamine sedations, the overall incidence of airway and respiratory adverse events was 3.9%, with the following significant independent predictors: younger than 2 years (odds ratio [OR] 2.00; 95% confidence interval [CI] 1.47 to 2.72), aged 13 years or older (OR 2.72; 95% CI 1.97 to 3.75), high intravenous dosing (initial dose > or =2.5 mg/kg or total dose > or =5.0 mg/kg; OR 2.18; 95% CI 1.59 to 2.99), coadministered anticholinergic (OR 1.82; 95% CI 1.36 to 2.42), and coadministered benzodiazepine (OR 1.39; 95% CI 1.08 to 1.78). Variables without independent association included oropharyngeal procedures, underlying physical illness (American Society of Anesthesiologists class >or = 3), and the choice of intravenous versus intramuscular route.
Risk factors that predict ketamine-associated airway and respiratory adverse events are high intravenous doses, administration to children younger than 2 years or aged 13 years or older, and the use of coadministered anticholinergics or benzodiazepines.
尽管氯胺酮是急诊科用于辅助儿童进行疼痛治疗最常用的镇静剂之一，但现有研究规模尚不足以确定可预测罕见气道和呼吸不良事件的临床因素。
我们汇总了32项急诊科研究的个体患者数据，并进行多因素逻辑回归分析，以确定哪些临床变量可预测气道和呼吸不良事件。
在8282例儿童氯胺酮镇静病例中，气道和呼吸不良事件的总体发生率为3.9%，以下为显著的独立预测因素：2岁以下（比值比[OR]2.00；95%置信区间[CI]1.47至2.72）、13岁及以上（OR 2.72；95%CI 1.97至3.75）、高静脉给药剂量（初始剂量≥2.5mg/kg或总剂量≥5.0mg/kg；OR 2.18；95%CI 1.59至2.99）、联合使用抗胆碱能药物（OR 1.82；95%CI 1.36至2.42）以及联合使用苯二氮卓类药物（OR 1.39；95%CI 1.08至1.78）。无独立关联的变量包括口咽手术、基础身体疾病（美国麻醉医师协会分级≥3级）以及静脉注射与肌肉注射途径的选择。
可预测氯胺酮相关气道和呼吸不良事件的风险因素为高静脉给药剂量、用于2岁以下或13岁及以上儿童以及联合使用抗胆碱能药物或苯二氮卓类药物。
