Betham Chris, Harvey Martyn, Cave Grant
Department of Emergency Medicine, Waikato Hospital, Hamilton, New Zealand.
N Z Med J. 2011 Oct 14;124(1344):46-53.
Procedural sedation has become widespread in emergency departments (ED) worldwide due to the ability to perform short turnaround noxious procedures beyond the confines of the operating theatre. We report one institution's experience with paediatric forearm fracture reduction and compare key time-based metrics for ED manipulation under procedural sedation (MUS), with traditional theatre-based manipulation under anaesthesia (MUA).
All simple paediatric forearm fractures requiring manipulation before casting at Waikato hospital during the 2009 calendar year were studied. Time from presentation to fracture manipulation, procedure room occupancy, and hospital length of stay were recorded. Requirement for repeated intervention was additionally collated.
Of 385 patients presenting with forearm fracture 108 underwent MUS and 66 MUA. Time to manipulation was shorter in the MUS group (58 plus or minus 38 minutes MUS vs. 558 plus or minus 368 minutes MUA; p<0.0001), as was hospital length of stay (139 plus or minus 70 minutes MUS vs 1452 plus or minus 544 minutes MUA; p<0.0001). No difference was observed in requirement for repeated intervention between groups (15% MUS vs 21% MUA; p=0.305).
Manipulation of simple closed paediatric forearm fractures under procedural sedation was associated with lesser delay to reduction, and shorter hospital length of stay, compared with traditional manipulation under anaesthesia in the operating theatre.
由于能够在手术室范围之外进行周转时间短的有害操作，程序镇静在全球急诊部门已广泛应用。我们报告了一家机构在小儿前臂骨折复位方面的经验，并比较了在程序镇静下急诊操作（MUS）与传统手术室麻醉下操作（MUA）的关键时间指标。
对2009年在怀卡托医院就诊且在石膏固定前需要进行复位的所有单纯小儿前臂骨折病例进行研究。记录从就诊到骨折复位的时间、操作室占用时间和住院时间。此外，还整理了重复干预的需求情况。
385例前臂骨折患者中，108例接受了程序镇静下的复位（MUS），66例接受了手术室麻醉下的复位（MUA）。MUS组的复位时间更短（MUS为58±38分钟，MUA为558±368分钟；p<0.0001），住院时间也更短（MUS为139±70分钟，MUA为1452±544分钟；p<0.0001）。两组之间在重复干预需求方面未观察到差异（MUS为15%，MUA为21%；p=0.305）。
与传统手术室麻醉下的操作相比，程序镇静下单纯闭合性小儿前臂骨折的复位延迟更短，住院时间也更短。
