Thomas Amber, Miller Jamie L, Couloures Kevin, Johnson Peter N
Department of Pharmacy, Clinical and Administrative Sciences,College of Pharmacy, University of Oklahoma, Oklahoma City, Oklahoma.
Yale New Haven Children's Hospital, New Haven, Connecticut.
J Pediatr Pharmacol Ther. 2015 Nov-Dec;20(6):418-30. doi: 10.5863/1551-6776-20.6.418.
The purpose of this study was to describe the method of delivery, dosage regimens, and outcomes of sedatives administered by extravascular route for imaging procedures in children.
Medline, Embase, International Pharmaceutical Abstracts, and Cochrane Database of Systematic Reviews were searched using keywords "child", "midazolam", "ketamine", dexmedetomidine", "fentanyl", "nitrous oxide", and "imaging." Articles evaluating the use of extravascular sedation in children for imaging procedures published in English between 1946 and March 2015 were included. Two authors independently screened each article for inclusion. Reports were excluded if they did not contain sufficient details on dosage regimens and outcomes.
Twenty reports representing 1,412 patients ranging in age from 0.33 to 19 years of age were included for analysis. Due to discrepancies in doses and types of analyses, statistical analyses were not performed. Oral midazolam was the most common agent evaluated; other agents included intranasal (IN) ketamine, IN midazolam, IN fentanyl, IN and transmucosal dexmedetomidine, and N2O. Most agents were considered efficacious compared with placebo.
Most agents showed efficacy for sedation during imaging when delivered through an extra-vascular route. Selection of agents should be based on onset time, duration, patient acceptability, recovery time, and adverse events. More robust studies are necessary to determine the optimal agent and route to utilize for imaging procedures when sedation is needed.
本研究旨在描述儿童在成像检查中通过血管外途径给予镇静剂的给药方法、剂量方案及结果。
使用关键词“儿童”“咪达唑仑”“氯胺酮”“右美托咪定”“芬太尼”“氧化亚氮”和“成像”检索Medline、Embase、国际药学文摘和Cochrane系统评价数据库。纳入1946年至2015年3月期间以英文发表的评估儿童在成像检查中使用血管外镇静的文章。两位作者独立筛选每篇文章以确定是否纳入。如果报告中没有关于剂量方案和结果的足够详细信息，则将其排除。
纳入20篇报告，共1412例患者，年龄范围为0.33至19岁，用于分析。由于剂量和分析类型存在差异，未进行统计分析。口服咪达唑仑是评估最常见的药物；其他药物包括鼻内（IN）氯胺酮、IN咪达唑仑、IN芬太尼、IN和经粘膜右美托咪定以及N2O。与安慰剂相比，大多数药物被认为是有效的。
大多数药物通过血管外途径给药时在成像检查期间显示出镇静效果。药物的选择应基于起效时间、持续时间、患者可接受性、恢复时间和不良事件。需要更有力的研究来确定在需要镇静时用于成像检查的最佳药物和途径。
