Gan Xiaoliang, Lin Haotian, Chen Jingjing, Lin Zhuoling, Lin Yiquan, Chen Weirong
Department of Anesthesiology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China.
Department of Cataract, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, People's Republic of China.
Clin Ther. 2016 Jun;38(6):1522-1529. doi: 10.1016/j.clinthera.2016.04.036. Epub 2016 May 24.
It is a challenge to rescue ophthalmology examinations performed in children in the sedation room after initial chloral hydrate failure. Intranasal dexmedetomidine can be used in rescue sedation in children undergoing computed tomography. The present study aimed to assess the efficacy and tolerability of intranasal dexmedetomidine use in children undergoing ophthalmic examination after chloral hydrate failure.
Sixty uncooperative pediatric patients with cataract (aged 5-36 months; weight, 7-15 kg) presented for follow-up ophthalmic examination. Patients who experienced chloral hydrate failure were randomized to 1 of 2 groups to receive intranasal dexmedetomidine 1 or 2 μg/kg for rescue sedation. Each group contained 30 patients. The primary outcome was the rate of a successful ophthalmic examination. Secondary outcomes included sedation onset time, recovery time, duration of examination, discharge time, and adverse events, including percentage of heart rate reduction, respiratory depression, vomiting, and postsedative agitation.
A successful ophthalmic examination was achieved in 93.3% (28/30) of patients in the 2-μg/kg dose group and in 66.7% (20/30) of patients in the 1-μg/kg dose group (P = 0.021). The onset time, recovery time, and discharge time did not significantly differ between the 2 groups. None of the patients required clinical intervention due to heart rate reduction, and none of the patients in either group experienced vomiting, respiratory depression, or agitation after the administration of dexmedetomidine.
In children undergoing ophthalmic examination, intranasal dexmedetomidine can be administered in the sedation room for rescue sedation after chloral hydrate failure, with the 2-μg/kg dose being more efficacious than the 1-μg/kg dose, as measured by success rate. ClinicalTrials.gov identifier: NCT02077712.
在最初使用水合氯醛失败后，在镇静室对儿童进行眼科检查的抢救是一项挑战。鼻内右美托咪定可用于接受计算机断层扫描的儿童的抢救镇静。本研究旨在评估鼻内使用右美托咪定对水合氯醛失败后接受眼科检查的儿童的疗效和耐受性。
60例不合作的白内障患儿（年龄5 - 36个月；体重7 - 15千克）前来进行眼科随访检查。经历水合氯醛失败的患者被随机分为2组中的1组，接受1或2μg/千克的鼻内右美托咪定进行抢救镇静。每组包含30名患者。主要结局是成功进行眼科检查的比例。次要结局包括镇静起效时间、恢复时间、检查持续时间、出院时间以及不良事件，包括心率降低的百分比、呼吸抑制、呕吐和镇静后激惹。
2μg/千克剂量组93.3%（28/30）的患者成功进行了眼科检查，1μg/千克剂量组66.7%（20/30）的患者成功进行了眼科检查（P = 0.021）。两组之间的起效时间、恢复时间和出院时间无显著差异。没有患者因心率降低需要临床干预，两组患者在给予右美托咪定后均未出现呕吐、呼吸抑制或激惹。
在接受眼科检查的儿童中，水合氯醛失败后可在镇静室给予鼻内右美托咪定进行抢救镇静，以成功率衡量，2μg/千克剂量比1μg/千克剂量更有效。ClinicalTrials.gov标识符：NCT02077712。
