Chandar Rumesh, Jagadisan Barath, Vasudevan Arumugam
*Department of Pediatrics †Department of Anesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
J Pediatr Gastroenterol Nutr. 2015 Jun;60(6):762-8. doi: 10.1097/MPG.0000000000000722.
There is a need to compare propofol requirement between propofol-ketamine (PK) and propofol-fentanyl (PF) given as nonanesthetist-administered propofol sedation during pediatric esophagogastroduodenoscopy (EGD).
The study was a parallel-group, randomized, double-blind comparison of the need for additional doses of propofol in the first minute after sedation induction between PK and PF, administered by rotating trainees in pediatrics for sedation during pediatric EGD. A total of 95 children with American Society of Anesthesiologists class I to III between 3 and 12 years undergoing EGD were included and randomized to either of the groups. After midazolam premedication, children received either 0.5 mg/kg ketamine (PK) or 1 μg/kg of fentanyl (PF) followed by a mandatory 1 mg/kg of propofol. Additional doses of propofol of 0.5 mg/kg each were given to achieve sedation induction (modified Ramsay scale level 6), and further doses were administered during the procedure as required. A total of 92 children (PK, n = 47; PF, n = 45) were analyzed. P < 0.05 was considered significant.
There was no difference in the propofol dose required for successful scope introduction and also in the need for additional propofol doses and the total additional propofol doses required in the first minute after sedation induction. Propofol injection pain was higher in the PF group (odds ratio 1.78). The adverse events and recovery time were similar. There was no escalation of care, airway intubations, death, or disability.
Nonanesthetist-administered propofol sedation is feasible in teaching hospitals. Propofol requirement is similar in both PK and PF combination regimens, but the lower frequency of propofol injection pain may favor the use of PK.
有必要比较在儿科食管胃十二指肠镜检查（EGD）期间，由非麻醉师给予丙泊酚镇静时，丙泊酚-氯胺酮（PK）和丙泊酚-芬太尼（PF）之间丙泊酚的需求量。
本研究为平行组、随机、双盲比较，比较PK组和PF组在镇静诱导后第一分钟额外丙泊酚剂量的需求情况，由儿科轮转实习医生在儿科EGD期间进行给药。共纳入95名年龄在3至12岁、美国麻醉医师协会分级为I至III级且接受EGD的儿童，并随机分为两组。在咪达唑仑预处理后，儿童接受0.5mg/kg氯胺酮（PK组）或1μg/kg芬太尼（PF组），随后强制给予1mg/kg丙泊酚。每次给予0.5mg/kg额外剂量的丙泊酚以达到镇静诱导（改良拉姆齐评分6级），并在操作过程中根据需要给予进一步剂量。共分析了92名儿童（PK组，n = 47；PF组，n = 45）。P < 0.05被认为具有统计学意义。
成功插入内镜所需的丙泊酚剂量、镇静诱导后第一分钟额外丙泊酚剂量的需求以及所需额外丙泊酚总剂量方面均无差异。PF组丙泊酚注射痛发生率更高（优势比1.78）。不良事件和恢复时间相似。没有出现病情升级、气道插管、死亡或残疾情况。
在教学医院，由非麻醉师给予丙泊酚镇静是可行的。PK和PF联合方案中丙泊酚需求量相似，但丙泊酚注射痛发生率较低可能更有利于PK的使用。
