Mandt Maria J, Roback Mark G, Bajaj Lalit, Galinkin Jeffrey L, Gao Dexiang, Wathen Joseph E
Department of Pediatrics, Section of Emergency Medicine, The Children's Hospital, University of Colorado Denver Health Science Center, Aurora, CO 80045, USA.
Pediatr Emerg Care. 2012 Sep;28(9):898-904. doi: 10.1097/PEC.0b013e318267c768.
This study aimed to prospectively determine the etomidate dose associated with adequate sedation and few significant respiratory events for procedures of short duration in children.
This is a prospective cohort study in an urban pediatric emergency department of patients 4 to 18 years requiring sedation and analgesia for painful procedures of short duration. Patients received fentanyl 1 μg/kg followed by intravenously administered etomidate 0.1 to 0.2 mg/kg as a loading dose. An additional dose of etomidate 0.1 mg/kg was intravenously administered if needed. The level of sedation was determined by The Children's Hospital of Wisconsin Sedation Score. The primary outcome was to determine the etomidate dose associated with an adequate level of sedation and procedural completion.
Sixty patients were enrolled. The most frequent procedure was fracture reduction (50/60, 83.3%). Procedures were successfully completed for 59 (98.3%) of 60 patients. The initial dose of etomidate associated with adequate sedation was 0.2 mg/kg intravenously administered for 33 (66.7%) of 50 patients requiring fracture reduction and for 6 (60.0%) of 10 patients receiving a procedure other than fracture reduction. Respiratory depression was noted in 9 (16.4%) of 55 patients, and oxygen desaturation was noted in 23 (39.0%) of 59 patients. Of 58 patients, 21 (36.2%) experienced a respiratory adverse event requiring brief intervention including oxygen supplementation, stimulation, and/or airway repositioning. No patient experienced a significant adverse respiratory event, defined as positive pressure ventilation. Median time to discharge-ready was 21 minutes.
For short-duration painful emergency department procedures, etomidate 0.2 mg/kg intravenously administered after fentanyl was associated with effective sedation, successful procedural completion, and readily managed respiratory adverse events in children.
本研究旨在前瞻性地确定与儿童短时间手术中充分镇静及较少严重呼吸事件相关的依托咪酯剂量。
这是一项在城市儿科急诊科进行的前瞻性队列研究，研究对象为4至18岁因短时间疼痛性手术需要镇静和镇痛的患者。患者先接受1μg/kg的芬太尼，随后静脉注射0.1至0.2mg/kg的依托咪酯作为负荷剂量。如有需要，再静脉注射额外剂量的0.1mg/kg依托咪酯。镇静水平由威斯康星儿童医院镇静评分确定。主要结局是确定与充分镇静水平及手术完成相关的依托咪酯剂量。
共纳入60例患者。最常见的手术是骨折复位（50/60，83.3%）。60例患者中有59例（98.3%）手术成功完成。与充分镇静相关的依托咪酯初始剂量为静脉注射0.2mg/kg，在50例需要骨折复位的患者中有33例（66.7%），在10例接受非骨折复位手术的患者中有6例（60.0%）。55例患者中有9例（16.4%）出现呼吸抑制，59例患者中有23例（39.0%）出现氧饱和度下降。58例患者中有21例（36.2%）经历了需要短暂干预的呼吸不良事件，包括补充氧气、刺激和/或气道重新定位。没有患者经历定义为正压通气的严重不良呼吸事件。出院准备就绪的中位时间为21分钟。
对于急诊科短时间疼痛性手术，芬太尼后静脉注射0.2mg/kg依托咪酯与儿童有效镇静、手术成功完成及易于处理的呼吸不良事件相关。
