Austin Hospital, Melbourne, Victoria, Australia.
Emerg Med Australas. 2011 Aug;23(4):466-73. doi: 10.1111/j.1742-6723.2011.01419.x. Epub 2011 May 17.
To determine the nature, incidence and risk factors for sedation-related events during ED procedural sedation, with particular focus on the drugs administered.
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 employed a specifically designed form. Multivariate logistic regression was employed to determine risk factors for sedation-related events.
Two thousand, six hundred and twenty-three patients were enrolled (60.3% male, mean age 39.2 years). Reductions of fracture/dislocations of shoulders, wrists and ankles were most common. Four hundred and sixty-one (17.6%) cases experienced at least one airway event that required intervention. Airway obstruction, hypoventilation and desaturation occurred in 12.7%, 6.4% and 3.7% of all patients, respectively. Two thousand, one hundred and forty-six cases had complete datasets for further analyses. Increasing age and level of sedation, pre-medication with fentanyl, and sedation with propofol, midazolam or fentanyl were risk factors for an airway event (P < 0.05). Ketamine was a protective factor. Hypotension (systolic pressure <80 mmHg) occurred in 34 (1.6%) cases with midazolam being a significant risk factor (P < 0.001). Vomiting also occurred in 34 (1.6%) cases, 12 of whom required an intervention. One patient aspirated. Vomiting occurred after administration of all drugs but was not associated with fasting status. Other events were rare.
Sedation-related events, especially airway events, are common but very rarely have an adverse outcome. Elderly patients, deeply sedated with short-acting agents, are at particular risk. The results will help tailor sedation to individual patients.
确定急诊程序镇静相关事件的性质、发生率和危险因素，特别关注所用药物。
2006 年 1 月至 2008 年 12 月，11 家澳大利亚急诊室连续纳入成年和儿科患者。如果镇静药物用于急诊程序，则纳入患者。数据采集是前瞻性的，并采用专门设计的表格。采用多变量逻辑回归确定镇静相关事件的危险因素。
共纳入 2623 例患者（60.3%为男性，平均年龄 39.2 岁）。减少肩部、腕部和踝部骨折/脱位最为常见。461 例（17.6%）至少发生 1 次需要干预的气道事件。气道阻塞、通气不足和血氧饱和度下降分别发生在所有患者的 12.7%、6.4%和 3.7%。2146 例患者有完整的数据集进行进一步分析。年龄增长和镇静程度增加、使用芬太尼预用药、使用异丙酚、咪达唑仑或芬太尼镇静是气道事件的危险因素（P<0.05）。氯胺酮是保护因素。使用咪达唑仑时发生低血压（收缩压<80mmHg）的有 34 例（1.6%），是一个显著的危险因素（P<0.001）。呕吐也发生在 34 例（1.6%）患者中，其中 12 例需要干预。1 例患者发生误吸。所有药物使用后均发生呕吐，但与禁食状态无关。其他事件很少见。
镇静相关事件，特别是气道事件很常见，但很少有不良后果。老年患者、使用短效药物深度镇静时风险特别高。结果将有助于针对个体患者调整镇静。
