Harvey Martyn, Cave Grant, Betham Chris
University of Auckland School of Medicine—and Department of Emergency Medicine, Waikato Hospital, Pembroke St, Hamilton, New Zealand.
N Z Med J. 2011 Oct 14;124(1344):36-45.
Procedural sedation is commonly employed in the emergency department to assist in performance of noxious or invasive procedures. Numerous studies exist purporting the safety and efficacy of procedural sedation in North America and Australia, however, little data on sedation practice within New Zealand has been reported. We present one-year experience of all procedural sedations performed at Waikato Hospital.
A prospective audit of all procedural sedations performed at the emergency department of Waikato hospital during the 2009 calendar year was conducted. Data abstraction included: indication for sedation, procedure duration, emergency department length of stay, required personnel, and procedural success, in addition to sedative agents employed and associated adverse events.
589 (276 paediatric, 313 adult) episodes of procedural sedation were available for analysis. Successful procedure performance was reported in 98% of paediatric cases and 88% of adult cases. Ketamine was the most commonly employed agent in the paediatric population (83.6%), with propofol the most frequently used in adults (99%). Procedural duration and emergency department length of stay was median 15 (IQR 10-25) minutes, and 122 (IQR 85-164) minutes respectively for the paediatric group, and median 15 (IQR 10-20) minutes and 124 (81-192) minutes for adult patients. Discharge rates for paediatric and adult patients were 87% and 52% respectively. Complication rates of procedural sedation for both groups was low.
Procedural sedation appears both safe and effective in performance of time-limited noxious manipulations in a 'real-life' emergency department setting in New Zealand.
在急诊科，程序镇静常用于辅助实施有害或侵入性操作。北美和澳大利亚有大量研究表明程序镇静具有安全性和有效性，然而，新西兰国内关于镇静实践的数据报道较少。我们介绍怀卡托医院一年来所有程序镇静的经验。
对2009年全年在怀卡托医院急诊科实施的所有程序镇静进行前瞻性审计。数据提取包括：镇静指征、操作持续时间、急诊科住院时间、所需人员、操作成功率，以及所使用的镇静剂和相关不良事件。
共有589例（276例儿科患者，313例成人患者）程序镇静病例可供分析。儿科病例的操作成功率为98%，成人病例为88%。氯胺酮是儿科人群中最常用的药物（83.6%），丙泊酚是成人中最常用的药物（99%）。儿科组的操作持续时间和急诊科住院时间中位数分别为15（四分位间距10 - 25）分钟和122（四分位间距85 - 164）分钟，成人患者分别为15（四分位间距10 - 20）分钟和124（81 - 192）分钟。儿科和成人患者的出院率分别为87%和52%。两组程序镇静的并发症发生率较低。
在新西兰“现实生活”中的急诊科环境下，程序镇静在实施限时有害操作时似乎既安全又有效。
