Lee Jin Hee, Kim Kyuseok, Kim Tae Yun, Jo You Hwan, Kim Seung Ho, Rhee Joong Eui, Heo Chan Yeong, Eun Seok-Chan
Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea.
Pediatr Emerg Care. 2012 Dec;28(12):1297-301. doi: 10.1097/PEC.0b013e3182768a86.
Ketamine is used intramuscularly or intravenously as a sedative when repairing the skin lacerations of children in many emergency departments (EDs). Nitrous oxide (N(2)O) has the advantages of being a sedative agent that does not require a painful injection and that offers shallower levels of sedation and a rapid recovery of mental state. We evaluated the clinical usefulness of N(2)O compared with intravenous ketamine when used for the repair of lacerations in children in the ED.
From January to December 2009, we performed a prospective, randomized study at a single academic ED enrolling pediatric patients aged 3 to 10 years who needed primary repair of a laceration wound. The primary outcome was recovery time, which was defined as the time from completion of procedure to recovery of mental state. Other outcomes were sedation depth, pain scale, adverse effects, and satisfaction with sedation.
There were 32 children who were randomly assigned. Recovery times were shorter in the N(2)O group compared with those in the ketamine group (median [interquartile range (IQR)], 0.0 minutes, [0.0-4.0 minutes] vs 21.5 minutes [12.5-37.5 minutes], P < 0.05). Sedation levels were deeper in the ketamine group than in the N2O group, but pain scales were comparable between groups. No difference was observed in the satisfaction scores by physicians, parents, or nurses.
Nitrous oxide inhalation was preferable to injectable ketamine for pediatric patients because it is safe, allows for a faster recovery, maintains sufficient sedation time, and does not induce unnecessarily deep sedation.
在许多急诊科（ED），氯胺酮在修复儿童皮肤裂伤时被用作肌肉注射或静脉注射镇静剂。一氧化二氮（N₂O）作为一种镇静剂，具有无需痛苦注射、镇静程度较浅且精神状态恢复迅速的优点。我们评估了在急诊科用于儿童裂伤修复时，N₂O与静脉注射氯胺酮相比的临床实用性。
2009年1月至12月，我们在一家学术性急诊科进行了一项前瞻性随机研究，纳入3至10岁需要一期修复裂伤伤口的儿科患者。主要结局是恢复时间，定义为从手术完成到精神状态恢复的时间。其他结局包括镇静深度、疼痛评分、不良反应以及对镇静的满意度。
32名儿童被随机分组。与氯胺酮组相比，N₂O组的恢复时间更短（中位数[四分位间距（IQR）]，0.0分钟，[0.0 - 4.0分钟] 对比 21.5分钟 [12.5 - 37.5分钟]，P < 0.05）。氯胺酮组的镇静水平比N₂O组更深，但两组间疼痛评分相当。医生、家长或护士的满意度评分未观察到差异。
对于儿科患者，吸入一氧化二氮优于注射氯胺酮，因为它安全、恢复更快、保持足够的镇静时间且不会引起不必要的深度镇静。
