Borland Meredith, Esson Amanda, Babl Franz, Krieser David
Princess Margaret Hospital, Perth, Western Australia, Australia.
Emerg Med Australas. 2009 Feb;21(1):71-9. doi: 10.1111/j.1742-6723.2008.01150.x.
To investigate current procedural sedation practice and compare clinical practice guidelines (CPG) for procedural sedation at Paediatric Research in Emergency Departments International Collaborative (PREDICT) sites. This will determine areas for improvement and provide baseline data for future multicentre studies.
A questionnaire of specialist emergency physicians regarding demographics, general procedural sedation practice and specific sedation agents given to children. CPG for general sedation and sedation agents were obtained for each site.
Seventy-five (71%) useable surveys returned from 105 potential respondents. Most commonly used agents were nitrous oxide (N(2)O) (75, 100%), ketamine (total 72, 96%; i.v. 59, 83% and i.m. 22, 31%) and midazolam (total 68, 91%; i.v. 52, 81%, oral 47, 73%, intranasal 26, 41% and i.m. 6, 9%). Sedation was used for therapeutic and diagnostic procedures. Forty-three (57%) used formal sedation records and sedation checklists and thirty-one (41%) respondents reported auditing sedations. Four sites ran staff education and competency programmes. Nine sites had general sedation CPG, eight for ketamine, nine for N(2)O, eight for midazolam (four parenteral, five oral and six intranasal) and three for fentanyl. No site had a guideline for propofol administration.
Procedural sedation in this research network commonly uses N(2)O, ketamine and midazolam for a wide range of procedures. Areas of improvement are the lack of guidelines for certain agents, documentation, staff competency training and auditing processes. Multicentre research could close gaps in terms of age cut-offs, fasting times and optimal indications for various agents.
调查儿科急诊科国际协作研究（PREDICT）站点当前的程序镇静实践情况，并比较程序镇静的临床实践指南（CPG）。这将确定改进领域，并为未来的多中心研究提供基线数据。
向专科急诊医生发放一份关于人口统计学、一般程序镇静实践以及给予儿童的特定镇静药物的调查问卷。获取每个站点的一般镇静和镇静药物的CPG。
从105名潜在受访者处共返回75份（71%）可用调查问卷。最常用的药物是氧化亚氮（N₂O）（75例，100%）、氯胺酮（共72例，96%；静脉注射59例，83%，肌肉注射22例，31%）和咪达唑仑（共68例，91%；静脉注射52例，81%，口服47例，73%，鼻内给药26例，41%，肌肉注射6例，9%）。镇静用于治疗和诊断程序。43名（57%）使用正式的镇静记录和镇静检查表，31名（41%）受访者报告对镇静情况进行审核。4个站点开展了员工教育和能力培训项目。9个站点有一般镇静的CPG，8个有氯胺酮的CPG，9个有氧化亚氮的CPG，8个有咪达唑仑的CPG（4个胃肠外给药、5个口服和6个鼻内给药），3个有芬太尼的CPG。没有站点有丙泊酚给药指南。
该研究网络中的程序镇静通常使用氧化亚氮、氯胺酮和咪达唑仑进行多种程序。需要改进的方面包括某些药物缺乏指南、文件记录、员工能力培训和审核流程。多中心研究可以在年龄界限、禁食时间和各种药物的最佳适应证方面填补空白。
