Poonai Naveen, Canton Kyle, Ali Samina, Hendrikx Shawn, Shah Amit, Miller Michael, Joubert Gary, Rieder Michael, Hartling Lisa
Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada.
Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada.
PLoS One. 2017 Mar 20;12(3):e0173253. doi: 10.1371/journal.pone.0173253. eCollection 2017.
Ketamine is commonly used for procedural sedation and analgesia (PSA) in children. Evidence suggests it can be administered intranasally (IN). We sought to review the evidence for IN ketamine for PSA in children.
We performed a systematic review of randomized trials of IN ketamine in PSA that reported any sedation-related outcome in children 0 to 19 years. Trials were identified through electronic searches of MEDLINE (1946-2016), EMBASE (1947-2016), Google Scholar (2016), CINAHL (1981-2016), The Cochrane Library (2016), Web of Science (2016), Scopus (2016), clinical trial registries, and conference proceedings (2000-2016) without language restrictions. The methodological qualities of studies and the overall quality of evidence were evaluated using the Cochrane Collaboration's Risk of Bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, respectively.
The review included 7 studies (n = 264) of children ranging from 0 to 14 years. Heterogeneity in study design precluded meta-analysis. Most studies were associated with a low or unclear risk of bias and outcome-specific ratings for quality of evidence were low or very low. In four of seven studies, IN ketamine provided superior sedation to comparators and resulted in adequate sedation for 148/175 (85%) of participants. Vomiting was the most common adverse effect; reported by 9/91 (10%) of participants.
IN ketamine administration is well tolerated and without serious adverse effects. Although most participants were deemed adequately sedated with IN ketamine, effectiveness of sedation with respect to superiority over comparators was inconsistent, precluding a recommendation for PSA in children.
氯胺酮常用于儿童的程序性镇静和镇痛（PSA）。有证据表明它可以经鼻内（IN）给药。我们试图回顾关于儿童PSA使用经鼻内氯胺酮的证据。
我们对经鼻内氯胺酮用于PSA的随机试验进行了系统评价，这些试验报告了0至19岁儿童任何与镇静相关的结果。通过对MEDLINE（1946 - 2016年）、EMBASE（1947 - 2016年）、谷歌学术（2016年）、CINAHL（1981 - 2016年）、考克兰图书馆（2016年）、科学网（2016年）、Scopus（2016年）、临床试验注册库和会议论文集（2000 - 2016年）进行电子检索来识别试验，检索无语言限制。分别使用考克兰协作网的偏倚风险工具和推荐分级评估、制定与评价（GRADE）系统对研究的方法学质量和证据的总体质量进行评估。
该评价纳入了7项针对0至14岁儿童的研究（n = 264）。研究设计的异质性排除了进行荟萃分析的可能性。大多数研究的偏倚风险较低或不明确，且针对证据质量的特定结局评级为低或极低。在7项研究中的4项中，经鼻内氯胺酮比对照药物提供了更好的镇静效果，并且使148/175（85%）的参与者获得了充分的镇静。呕吐是最常见的不良反应；9/91（10%）的参与者报告有呕吐。
经鼻内给予氯胺酮耐受性良好，且无严重不良反应。尽管大多数参与者被认为经鼻内氯胺酮镇静效果良好，但与对照药物相比，其镇静效果的优越性并不一致，因此不推荐将其用于儿童PSA。
