Dela Cruz Jonathan E, Sullivan Donald N, Varboncouer Eric, Milbrandt Joseph C, Duong Myto, Burdette Scott, O'Keefe Daniel, Scaife Steven L, Saleh Khaled J
Southern Illinois University School of Medicine, Department of Surgery, Division of Emergency Medicine, Springfield, Illinois.
Southern Illinois University School of Medicine, Department of Surgery, Division of Orthopaedics, Springfield, Illinois.
West J Emerg Med. 2014 Feb;15(1):76-80. doi: 10.5811/westjem.2013.7.15616.
Various types of sedation can be used for the reduction of a dislocated total hip arthroplasty. Traditionally, an opiate/benzodiazepine combination has been employed. The use of other pharmacologic agents, such as etomidate and propofol, have more recently gained popularity. Currently no studies directly comparing these sedation agents have been carried out. The purpose of this study is to compare differences in reduction and sedation outcomes, including recovery times, of these 3 sedation agents.
We performed a retrospective chart review examining 198 patients who presented with dislocated total hip arthroplasty at 2 academic affiliated medical centers. The patients were grouped according to the type of sedation agent. We calculated percentages of reduction and sedation complications along with recovery times. Reduction complications included fracture, skin or neurovascular injury, and failure of reduction requiring general anesthesia. Sedation complications included use of bag-valve mask and artificial airway, intubation, prolonged recovery, use of a reversal agent, and inability to achieve sedation. We then compared the data for each sedation agent.
We found reduction complications rates of 8.7% in the propofol, 24.7% in the etomidate, and 28.9% in the opiate/benzodiazepine groups. The propofol group was significantly different from the other 2agents (p ≤ 0.01). Sedation complications were found 7.3% of the time in the propofol , 11.7% in the etomidate , and 21.3% in the opiate/benzodiazepine group, (p=0.02 propofol vs. others) . Average recovery times were 25.2 minutes for propofol, 30.8 minutes for etomidate, and 44.4 minutes for opiate/benzodiazepine (p = 0.05 for propofol vs. other agents).
For reduction of dislocated total hip arthroplasty under procedural sedation, propofol appears to have fewer complications and a trend toward more rapid recovery than both etomidate and opiate/benzodiazepine. These data support the use of propofol as first line agent for procedural sedation of dislocated total hip arthroplasty, with fewer complications and a shorter recovery period.
多种类型的镇静方法可用于复位脱位的全髋关节置换术。传统上，采用阿片类药物/苯二氮䓬类药物联合使用。其他药物如依托咪酯和丙泊酚的使用最近越来越普遍。目前尚未进行直接比较这些镇静药物的研究。本研究的目的是比较这三种镇静药物在复位及镇静效果方面的差异，包括恢复时间。
我们对两家学术附属医疗中心的198例脱位全髋关节置换术患者进行了回顾性病历审查。患者根据镇静药物类型分组。我们计算了复位及镇静并发症的百分比以及恢复时间。复位并发症包括骨折、皮肤或神经血管损伤以及需要全身麻醉的复位失败。镇静并发症包括使用气囊面罩和人工气道、插管、恢复时间延长、使用拮抗剂以及无法达到镇静效果。然后我们比较了每种镇静药物的数据。
我们发现丙泊酚组的复位并发症发生率为8.7%，依托咪酯组为24.7%，阿片类药物/苯二氮䓬类药物组为28.9%。丙泊酚组与其他两组有显著差异（p≤0.01）。丙泊酚组的镇静并发症发生率为7.3%，依托咪酯组为11.7%，阿片类药物/苯二氮䓬类药物组为21.3%，（丙泊酚与其他组相比，p = 0.02）。丙泊酚的平均恢复时间为25.2分钟，依托咪酯为30.8分钟，阿片类药物/苯二氮䓬类药物为44.4分钟（丙泊酚与其他药物相比，p = 0.05）。
对于在程序性镇静下复位脱位的全髋关节置换术，丙泊酚似乎比依托咪酯和阿片类药物/苯二氮䓬类药物并发症更少，且有恢复更快的趋势。这些数据支持将丙泊酚作为脱位全髋关节置换术程序性镇静的一线药物，其并发症更少，恢复时间更短。
