Patel Meral M, Kamat Pradip P, McCracken Courtney E, Simon Harold K
Departments of Pediatrics, and
Departments of Pediatrics, and Children's Healthcare of Atlanta, Atlanta, Georgia.
Hosp Pediatr. 2016 Feb;6(2):95-102. doi: 10.1542/hpeds.2015-0065. Epub 2016 Jan 1.
Pediatric oncology patients frequently undergo procedural sedation. The goal of this study was to determine the safety of combining procedures into a single sedation encounter and to assess if the magnitude of any complication is significant enough to justify separate sedation encounters for multiple procedures.
This retrospective review included pediatric oncology patients sedated for lumbar puncture alone or combined procedures (lumbar puncture and bone marrow aspirate) from January 2012 to January 2014. Demographic characteristics, medication dosing, procedural success, sedation duration, and adverse events (AEs) with associated required interventions were recorded. Sedation-related complications were separated into serious adverse events (SAEs) and AEs. Data were analyzed by using multivariable modeling.
Data from 972 sedation encounters involving 96 patients, each having 1 to 28 encounters (mean±SD, 10±5), were reviewed. Ninety percent were individual procedures and 10% were combined procedures. Overall, there were few SAEs, and airway obstruction was the most common SAE. Combined procedures required 0.31 mg/kg more propofol (P<.001) and took 1.4 times longer (P<.001) than individual procedures. In addition, when adjusting for possible confounding factors, the odds of having an SAE were 4.8 (95% confidence interval, 1.37-16.65); P=.014) times higher for combined procedures. All SAEs and AEs were manageable by the sedation team.
Combining procedures was associated with higher propofol doses, prolonged duration, and a small increase in likelihood of SAEs compared with individual procedures. All AEs fell within the scope of management by the sedation team. Balancing the increased, but manageable, risks versus the advantages of family/patient convenience, enhanced resource utilization, and minimization of potential neurotoxicity from anesthetics supports combining procedures when possible.
儿科肿瘤患者经常接受程序性镇静。本研究的目的是确定将多项操作合并在一次镇静过程中的安全性，并评估任何并发症的严重程度是否足以证明对多项操作进行单独的镇静过程是合理的。
这项回顾性研究纳入了2012年1月至2014年1月期间因单纯腰椎穿刺或联合操作（腰椎穿刺和骨髓穿刺）而接受镇静的儿科肿瘤患者。记录人口统计学特征、药物剂量、操作成功率、镇静持续时间以及伴有相关所需干预措施的不良事件（AE）。与镇静相关的并发症分为严重不良事件（SAE）和AE。采用多变量模型进行数据分析。
回顾了972次镇静过程的数据，涉及96例患者，每位患者有1至28次镇静过程（平均±标准差，10±5）。90%为单独操作，10%为联合操作。总体而言，严重不良事件较少，气道梗阻是最常见的严重不良事件。联合操作比单独操作需要多0.31mg/kg的丙泊酚（P<0.001），且耗时长1.4倍（P<0.001）。此外，在调整可能的混杂因素后，联合操作发生严重不良事件的几率高出4.8倍（95%置信区间，1.37 - 16.65；P = 0.014）。所有严重不良事件和不良事件均可由镇静团队处理。
与单独操作相比，联合操作与更高的丙泊酚剂量、更长的持续时间以及严重不良事件发生率的小幅增加相关。所有不良事件均在镇静团队的管理范围内。权衡增加但可控的风险与家庭/患者便利性、提高资源利用率以及将麻醉剂潜在神经毒性降至最低等优势，支持尽可能合并操作。
