Ricard C, Tichit R, Troncin R, Bernard F
Unité d'analgésie pédiatrique, service d'anesthésie-réanimation A, hôpital Lapeyronie, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France, Unité d'oncologie pédiatrique, pédiatrie III, hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 05, France.
Bull Cancer. 2009 Sep 1;96 Suppl 2:15-20. doi: 10.1684/bdc.2009.0890.
Procedural sedation and analgesia for children is widely practiced. Since 2005 to 2007, we evaluated the safety and efficacy of ketamine to control pain induced by diagnostic procedures in pediatric oncology patients. Eight hundred fifty procedures were carried out in 125 patients aged 2 to 16 years. We associated EMNO (inhaled equimolar mixture of nitrous oxide and oxygen), atropin (oral or rectal), midazolam (oral or rectal) and ketamin (intravenous). An anesthesiologist injected ketamin. Average dose of ketamine was 0.33 to 2 mg/kg depending on number and invasiveness of procedures. This method requires careful monitoring and proper precautions. With these conditions, no complication was observed. All patients were effectively sedated. These results indicate that ketamine - in association with EMNO, atropine and midazolam - is safe and effective in pain management induced by diagnostic procedures in pediatric oncology patients. The sedative regimen of intravenous ketamine has greatly reduced patient, family and practitioners anxiety for diagnostic and therapeutic procedures.
儿童程序性镇静和镇痛应用广泛。在2005年至2007年期间，我们评估了氯胺酮在控制儿科肿瘤患者诊断性操作所致疼痛方面的安全性和有效性。对125名年龄在2至16岁的患者实施了850次操作。我们联合使用了EMNO（氧化亚氮和氧气的吸入等摩尔混合物）、阿托品（口服或直肠给药）、咪达唑仑（口服或直肠给药）和氯胺酮（静脉注射）。由一名麻醉医生注射氯胺酮。根据操作的次数和侵入性，氯胺酮的平均剂量为0.33至2毫克/千克。该方法需要仔细监测并采取适当的预防措施。在这些条件下，未观察到并发症。所有患者均得到有效镇静。这些结果表明，氯胺酮与EMNO、阿托品和咪达唑仑联合使用，在儿科肿瘤患者诊断性操作所致疼痛管理中是安全有效的。静脉注射氯胺酮的镇静方案大大减轻了患者、家属和医护人员对诊断和治疗操作的焦虑。
