Cravero Joseph P, Beach Michael L, Blike George T, Gallagher Susan M, Hertzog James H
Department of Anesthesiology and Pediatrics, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756-0001, USA.
Anesth Analg. 2009 Mar;108(3):795-804. doi: 10.1213/ane.0b013e31818fc334.
We used a large database of prospectively collected data on pediatric sedation/anesthesia outside the operating room provided by a wide range of pediatric specialists to delineate the nature and frequency of adverse events associated with propofol-based sedation/anesthesia care.
Data were collected by the Pediatric Sedation Research Consortium, a collaborative group of institutions dedicated to improving sedation/anesthesia care for children internationally. Members prospectively enrolled consecutive patients receiving sedation or sedation/anesthesia for procedures. The primary inclusion criterion was the need for some form of sedation/anesthesia to perform a diagnostic or therapeutic procedure outside the operating room. There were no exclusion criteria. Data on demographics, primary illness, coexisting illness, procedure performed, medications used, procedure and recovery times, medication doses outcomes of anesthesia, airway interventions and adverse events were collected and reported using web-based data collection tool. For this study, we evaluated all instances where propofol was used as the primary drug in the sedation/anesthesia technique.
Thirty-seven locations submitted data on 49,836 propofol sedation/anesthesia encounters during the study period from July 1, 2004 until September 1, 2007. There were no deaths. Cardiopulmonary resuscitation was required twice. Aspiration during sedation/anesthesia occurred four times. Less serious events were more common with O(2) desaturation below 90% for more than 30 s, occurring 154 times per 10,000 sedation/anesthesia administrations. Central apnea or airway obstruction occurred 575 times per 10,000 sedation/anesthesia administrations. Stridor, laryngospasm, excessive secretions, and vomiting had frequencies of 50, 96, 341, and 49 per 10,000 encounters, respectively. Unexpected admissions (increases in levels of care required) occurred at a rate of 7.1 per 10,000 encounters. In an unadjusted analysis, the rate of pulmonary adverse events was not different for anesthesiologists versus other providers.
We report the largest series of pediatric propofol sedation/anesthesia for procedures outside the operating room. The data indicate that propofol sedation/anesthesia is unlikely to yield serious adverse outcomes in a collection of institutions with highly motivated and organized sedation/anesthesia services. However, the safety of this practice is dependent on a system's ability to manage less serious events. We propose that our data suggest variables for training and credentialing providers of propofol sedation/anesthesia and the system characteristics that promote safe use of this drug.
我们使用了一个大型数据库，该数据库前瞻性收集了由众多儿科专家提供的关于手术室以外儿科镇静/麻醉的数据，以描述与丙泊酚镇静/麻醉护理相关不良事件的性质和发生率。
数据由儿科镇静研究联盟收集，该联盟是一个致力于在国际上改善儿童镇静/麻醉护理的机构合作组织。成员前瞻性纳入连续接受镇静或镇静/麻醉以进行手术的患者。主要纳入标准是在手术室以外进行诊断或治疗手术时需要某种形式的镇静/麻醉。没有排除标准。使用基于网络的数据收集工具收集并报告有关人口统计学、原发性疾病、并存疾病、进行的手术、使用的药物、手术和恢复时间、麻醉药物剂量、气道干预和不良事件的数据。对于本研究，我们评估了所有将丙泊酚用作镇静/麻醉技术主要药物的情况。
在2004年7月1日至2007年9月1日的研究期间，37个地点提交了49836例丙泊酚镇静/麻醉病例的数据。无死亡病例。需要进行两次心肺复苏。镇静/麻醉期间发生4次误吸。不太严重的事件中，氧饱和度低于90%超过30秒更为常见，每10000次镇静/麻醉给药发生154次。中枢性呼吸暂停或气道阻塞每10000次镇静/麻醉给药发生575次。喘鸣、喉痉挛、分泌物过多和呕吐的发生率分别为每10000次病例50次、96次、341次和49次。意外住院（所需护理级别增加）发生率为每10000次病例7.1次。在未经调整的分析中，麻醉医生与其他医疗人员的肺部不良事件发生率无差异。
我们报告了关于手术室以外儿科丙泊酚镇静/麻醉的最大系列病例。数据表明，在拥有积极性高且组织有序的镇静/麻醉服务的一系列机构中，丙泊酚镇静/麻醉不太可能产生严重不良后果。然而，这种做法的安全性取决于系统处理不太严重事件的能力。我们建议我们的数据为丙泊酚镇静/麻醉医疗人员的培训和资质认证以及促进该药物安全使用的系统特征提供变量参考。
