The Hospital for Sick Children (Sickkids), , Toronto, Ontario, Canada.
Br J Ophthalmol. 2013 Nov;97(11):1437-42. doi: 10.1136/bjophthalmol-2013-303818. Epub 2013 Sep 17.
To report the largest study on the safety and effectiveness of sedation in paediatric ophthalmology in a nurse-led outpatient sedation unit.
Retrospective cohort study reviewing all children who underwent sedation from January 2006 to December 2010. Patients were sedated with 80 mg/kg of chloral hydrate (CH) given orally with top up dose given at half dose as required. All demographic data, sedation and procedure duration, sedation success and adverse events were recorded. Univariate and multiple regression analyses were performed to assess factors associated with success and complications.
Data was collected for 1509 sedation episodes. More boys were sedated compared with girls (56.3% vs 43.7% p=0.0003) with an average age of 23.86 months and weight of 11.76 kg. A higher proportion of patients had an American Society of Anaesthesiologists status of II than I (58.5%:41.5%, p=0.0001). Successful sedation was obtained in 96.69% of children with 4.77% requiring a top up dose to achieve this. The average sedation duration was 53.4 min (SD=21.5) with an average of 1.7 procedures performed; the most common being a detailed examination (93.5%) and electroretinogram (45.1%). Adverse events included paradoxical reaction (1.33%), oxygen desaturation (0.99%) and vomiting (0.53%). There were no serious complications or hospital admission. Multiple logistic regression analysis found weight greater than 15 kg and needing a top up dose to be significant risk factors for Failure (OR=2.49 and 8.69, respectively) and Adverse events (OR=2.1 and 3.97, respectively). Sex and American Society of Anesthesiologists Physical Status score did not significantly affect outcomes.
CH sedation allows detailed examination and investigations in the majority of children with few side effects. Patients over 15 kg and need for a top up dose are risk factors for failure and adverse events. This is the largest study in the current literature looking at the use of CH sedation in ophthalmology and confirms its safety and effectiveness.
报告在护士主导的门诊镇静单位中，小儿眼科镇静安全性和有效性的最大研究。
回顾性队列研究，对 2006 年 1 月至 2010 年 12 月期间接受镇静的所有儿童进行了研究。患者口服给予 80mg/kg 水合氯醛（CH）镇静，并根据需要给予半剂量的追加剂量。记录所有人口统计学数据、镇静和手术持续时间、镇静成功率和不良事件。进行单变量和多变量回归分析，以评估与成功率和并发症相关的因素。
共收集了 1509 例镇静发作的数据。与女孩（56.3%比 43.7%，p=0.0003）相比，更多男孩接受了镇静治疗，平均年龄为 23.86 个月，体重为 11.76kg。具有美国麻醉医师协会状态 II 的患者比例高于 I（58.5%比 41.5%，p=0.0001）。96.69%的儿童镇静成功，4.77%的儿童需要追加剂量才能达到镇静效果。平均镇静持续时间为 53.4 分钟（SD=21.5），平均进行 1.7 次手术；最常见的是详细检查（93.5%）和视网膜电图（45.1%）。不良事件包括矛盾反应（1.33%）、氧饱和度下降（0.99%）和呕吐（0.53%）。无严重并发症或住院治疗。多变量逻辑回归分析发现，体重大于 15kg 和需要追加剂量是失败（OR=2.49 和 8.69）和不良事件（OR=2.1 和 3.97）的显著危险因素。性别和美国麻醉医师协会身体状况评分对结果无显著影响。
CH 镇静可使大多数儿童进行详细检查和检查，副作用较少。体重超过 15kg 和需要追加剂量是失败和不良事件的危险因素。这是目前文献中关于 CH 镇静在眼科中的应用的最大研究，证实了其安全性和有效性。
