Kendrick Dawn B, Monroe Kathy W, Bernard David W, Tofil Nancy M
Department of Pediatrics, Division of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Pediatr Emerg Care. 2009 Jun;25(6):393-6. doi: 10.1097/PEC.0b013e3181a7923b.
Etomidate is an imidazole hypnotic which is commonly used by emergency medicine physicians during rapid sequence intubation. Etomidate's duration of action is significantly shorter than that of commonly used long-acting paralytic medications (3-12 minutes vs 25-73 minutes). If additional sedative medications are not administered in the paralyzed patient before the conclusion of etomidate's duration of action, patients are at risk for experiencing paralysis without adequate sedation.
To evaluate the frequency of the administration of additional sedation in pediatric emergency department patients undergoing endotracheal intubation with etomidate and a long-acting paralytic agent.
This study was a retrospective review of pediatric patients undergoing endotracheal intubation in a tertiary pediatric emergency department between July 2001 and December 2005. All patients intubated with etomidate and rocuronium or vecuronium were eligible for inclusion; patients with seizures were excluded. Data elements included the following: demographic variables, presenting complaint, intubation indication, medications used, time from etomidate administration to the administration of an additional sedative, Glasgow Coma Scale (GCS) score, and patient disposition.
During the study period, 276 pediatric intubations were reviewed with 104 patients receiving etomidate and rocuronium or vecuronium. Twenty cases were excluded, 15 cases with documented seizures and 5 incomplete/missing charts. Eighty-four records were included in the final analysis. The mean age is 84 +/- 65 months; 62 (73.8%) patients were male; the mean GCS was 8.44 +/- 3.9, with a median GCS of 8 (interquartile range 6,11), and 41 (48.8%) of patients presented with blunt trauma. The mean time from etomidate to the administration of additional sedation was 46 +/- 49 minutes. Eleven (13.1%) patients received no additional sedative after etomidate administration, whereas only 20 (23.8%) patients were given a sedative within 15 minutes of the administration of etomidate. Fifty-three (63.1%) patients received an additional sedative more than 15 minutes after the administration of etomidate.
A significant proportion of pediatric patients receiving etomidate and rocuronium or vecuronium during endotracheal intubation are likely experiencing ongoing paralysis without adequate sedation. Emergency medicine physicians should be cognizant of this when using these medications for facilitating intubation.
依托咪酯是一种咪唑类催眠药，常用于急诊医学医生进行快速顺序诱导插管时。依托咪酯的作用持续时间明显短于常用的长效麻痹药物（3 - 12分钟对比25 - 73分钟）。如果在依托咪酯作用持续时间结束前未给麻痹患者使用额外的镇静药物，患者有在未充分镇静的情况下经历麻痹的风险。
评估在接受依托咪酯和长效麻痹剂进行气管插管的儿科急诊科患者中额外使用镇静药物的频率。
本研究是对2001年7月至2005年12月期间在一家三级儿科急诊科接受气管插管的儿科患者进行的回顾性研究。所有使用依托咪酯和罗库溴铵或维库溴铵进行插管的患者均符合纳入标准；癫痫发作患者被排除。数据元素包括以下内容：人口统计学变量、主诉、插管指征、使用的药物、从依托咪酯给药到给予额外镇静药物的时间、格拉斯哥昏迷量表（GCS）评分以及患者处置情况。
在研究期间，共审查了276例儿科插管病例，其中104例患者接受了依托咪酯和罗库溴铵或维库溴铵。排除20例，15例有癫痫发作记录，5例病历不完整/缺失。最终分析纳入84份记录。平均年龄为84±65个月；62例（73.8%）患者为男性；平均GCS为8.44±3.9，GCS中位数为8（四分位间距6,11），41例（48.8%）患者为钝性创伤。从依托咪酯给药到给予额外镇静药物的平均时间为46±49分钟。11例（13.1%）患者在依托咪酯给药后未接受额外镇静药物，而仅20例（23.8%）患者在依托咪酯给药后15分钟内给予了镇静药物。53例（63.1%）患者在依托咪酯给药15分钟后接受了额外镇静药物。
在气管插管期间接受依托咪酯和罗库溴铵或维库溴铵的相当一部分儿科患者可能在未充分镇静的情况下持续处于麻痹状态。急诊医学医生在使用这些药物辅助插管时应认识到这一点。
