University of Melbourne, Emergency Department, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
Emerg Med J. 2010 Aug;27(8):607-12. doi: 10.1136/emj.2009.084384. Epub 2010 Jun 1.
Large, mainly North American, series has shown the safety of paediatric procedural sedation in the emergency department (ED). However, sedation practices elsewhere differ. This study set out to investigate the sedation practice and the associated adverse events profile at the largest Australian paediatric ED.
Review of a prospective single centre procedural sedation registry database at an urban tertiary children's hospital ED in Australia with an annual census of 67 000 patients over a 4-year period (2004-8). Sedation records were supplemented with medical record review. Patients 18 years and older were excluded. Demographics, agents used, adverse events and complications were analysed descriptively.
Over the 4-year period, 2002 patients underwent procedural sedation. The median age was 5.7 years. Nitrous oxide was used in 1625 (81%), ketamine in 335 (17%) and midazolam in 39 (2%). Propofol and chloral hydrate were used in two and one patient, respectively. Most sedations were for laceration repair (38%) and orthopaedic procedures (33%); 89% had no adverse events. Most adverse events were mild, mainly vomiting (8%). Serious adverse events were desaturation in 12 patients, seizures in two patients and chest pain in one patient. The maximum required airway support was bag mask ventilation. No patients aspirated or required intubation.
In variation to reported practice elsewhere, almost all procedures in this Australian series were undertaken using nitrous oxide and ketamine. The serious adverse events rate was low.
多项主要来自北美的大型研究表明，在急诊科（ED）对儿科患者进行程序性镇静是安全的。然而，其他地方的镇静实践有所不同。本研究旨在调查澳大利亚最大的儿科 ED 的镇静实践和相关不良事件概况。
对澳大利亚城市三级儿童医院 ED 的前瞻性单中心程序性镇静登记数据库进行回顾，该数据库在 4 年期间（2004-2008 年）对每年 67000 名患者进行了普查。镇静记录通过病历回顾进行补充。排除 18 岁及以上的患者。对患者的人口统计学数据、使用的药物、不良事件和并发症进行描述性分析。
在 4 年期间，有 2002 名患者接受了程序性镇静。中位年龄为 5.7 岁。1625 名患者（81%）使用了一氧化二氮，335 名患者（17%）使用了氯胺酮，39 名患者（2%）使用了咪达唑仑。两名患者使用了异丙酚，一名患者使用了水合氯醛。大多数镇静用于裂伤修复（38%）和骨科手术（33%）；89%的患者没有不良事件。大多数不良事件为轻度，主要为呕吐（8%）。严重不良事件为 12 例患者出现血氧饱和度下降，2 例患者出现癫痫发作，1 例患者出现胸痛。需要的气道支持最大为球囊面罩通气。没有患者发生误吸或需要插管。
与其他地方报告的实践不同，本澳大利亚系列研究中的几乎所有手术都使用了一氧化二氮和氯胺酮。严重不良事件发生率较低。
