Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia.
J Pediatr Gastroenterol Nutr. 2012 Jun;54(6):748-52. doi: 10.1097/MPG.0b013e31824504af.
Numerous publications on sedation of and anaesthesia for diagnostic procedures in children prove that no ideal scheme is available. Therefore, we decided to study the protocol with midazolam and ketamine used by nonanaesthetists at our institution. The study aimed to establish the lowest effective starting dose of ketamine and to estimate a difference in the frequency of adverse reactions with or without the use of midazolam as premedication, with special stress on emergence reactions.
During 1 year we prospectively randomised children scheduled for gastrointestinal endoscopies to a first group with and to a second group without midazolam premedication. The starting ketamine dose was increased until the appropriate dissociative state was reached. Physiological functions were closely monitored and adverse reactions noted.
The median age of 201 analysed patients (111 girls, 90 boys) was 8.2 years. The median starting dose of ketamine was 0.97 mg/kg (the group with midazolam premedication) and 0.99 mg/kg TT (without midazolam premedication). Laryngospasm was observed in 6 patients without statistical difference between the 2 groups. All of the adverse reactions were short lasting; they resolved by symptomatic treatment without complications. Emergence reactions during the observation period at the hospital occurred more often in the group sedated with ketamine without midazolam premedication (P=0.02).
: The sedation protocol with ketamine is safe and efficient. The starting dose of ketamine should be at least 1 mg/kg. There is an advantage to the use of midazolam as premedication before ketamine in paediatric patients because the frequency of emergence reactions in hospital was reduced compared with sole ketamine use.
大量关于儿童诊断程序镇静和麻醉的出版物表明，目前尚无理想的方案。因此，我们决定研究我院非麻醉医生使用咪达唑仑和氯胺酮的方案。本研究旨在确定氯胺酮的最低有效起始剂量，并评估在使用或不使用咪达唑仑作为预给药的情况下，不良反应的发生频率是否存在差异，特别强调苏醒期反应。
在 1 年内，我们前瞻性地将接受胃肠内窥镜检查的儿童随机分为第一组（使用咪达唑仑预给药）和第二组（未使用咪达唑仑预给药）。逐渐增加氯胺酮的起始剂量，直至达到适当的分离状态。密切监测生理功能并记录不良反应。
201 名分析患者（111 名女孩，90 名男孩）的中位年龄为 8.2 岁。氯胺酮的中位起始剂量为 0.97mg/kg（咪达唑仑预给药组）和 0.99mg/kg TT（无咪达唑仑预给药组）。6 名患者出现喉痉挛，但两组间无统计学差异。所有不良反应均为短暂性，经对症治疗后无并发症。在医院观察期间，未使用咪达唑仑预给药的单独使用氯胺酮镇静组的苏醒期反应更常见（P=0.02）。
氯胺酮镇静方案安全有效。氯胺酮的起始剂量应至少为 1mg/kg。在儿科患者中，咪达唑仑作为氯胺酮预给药具有优势，因为与单独使用氯胺酮相比，苏醒期反应在医院的发生频率降低。
