Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia.
Emerg Med Australas. 2011 Aug;23(4):458-65. doi: 10.1111/j.1742-6723.2011.01418.x. Epub 2011 May 17.
The aim of the present study was to describe procedural sedation practices undertaken in a spectrum of Australian EDs.
Eleven Australian EDs enrolled consecutive adult and paediatric patients between January 2006 and December 2008. Patients were included if a sedative drug was administered for an ED procedure. Data collection was prospective and used a specifically designed data collection document.
2623 patients were enrolled. 1581 were male (60.3%, 95% CI 58.4-62.2) and the mean patient age was 39.2 (SD 25.2) years. Reductions of fracture/dislocated shoulders (694 cases, 26.7%), wrist/forearm fractures (403, 15.5%) and tibia/fibula fractures (341, 13.1%) were the most common procedures. Procedures were supervised by consultants and registrars in 1424 (54.3%) and 1025 (39.1%) cases, respectively. Of 2413 patients with complete fasting status data, 1252 (51.9%, 95% CI 49.9-53.9) patients had consumed food or fluid in the previous 6 h. 1399 (53.3%, 95% CI 51.4-55.3) patients received pre-procedural medication. Pre-procedural morphine (894, 34.1%) exceeded fentanyl use (323, 12.3%), both as a sole agent and in combination with another agent. The principal sedatives used alone were propofol (857, 38.5%), midazolam (224, 10%) and ketamine (165, 7.4%). Ketamine and nitrous oxide were most commonly used in children with propofol, midazolam and opiates largely restricted to adults (P < 0.001). The intra-procedural use of adjunct fentanyl exceeded that of morphine (ratio 4:1).
Procedural sedation practice across Australian EDs is varies considerably. Procedural sedation 'best practice' guidelines, based upon the findings of the present study and the available evidence, are recommended.
本研究旨在描述澳大利亚一系列急诊部实施的程序镇静实践。
2006 年 1 月至 2008 年 12 月期间，11 家澳大利亚急诊部连续纳入成年和儿科患者。如果镇静药物用于急诊部程序，则纳入患者。数据收集是前瞻性的，使用了专门设计的数据收集文件。
共纳入 2623 例患者。男性 1581 例（60.3%，95%CI 58.4-62.2），平均年龄 39.2（SD 25.2）岁。肩部（694 例，26.7%）、腕部/前臂（403 例，15.5%）和胫骨/腓骨（341 例，13.1%）骨折脱位复位是最常见的程序。2413 例患者中有完整禁食状态数据，1252 例（51.9%，95%CI 49.9-53.9）患者在 6 小时内进食或液体。1399 例（53.3%，95%CI 51.4-55.3）患者接受了术前用药。术前使用吗啡（894 例，34.1%）超过了芬太尼（323 例，12.3%），两者均为单独用药和联合用药。单独使用的主要镇静剂是丙泊酚（857 例，38.5%）、咪达唑仑（224 例，10%）和氯胺酮（165 例，7.4%）。氯胺酮和一氧化二氮在儿童中最常与丙泊酚、咪达唑仑和阿片类药物联合使用，而后者主要限于成人（P < 0.001）。术中辅助使用芬太尼超过了吗啡（比例为 4:1）。
澳大利亚急诊部的程序镇静实践差异很大。建议根据本研究结果和现有证据制定程序镇静“最佳实践”指南。
