Weisz Keith, Bajaj Lalit, Deakyne Sara J, Brou Lina, Brent Alison, Wathen Joseph, Roosevelt Genie E
Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, Aurora, Colorado.
Department of Research Informatics, Children's Hospital Colorado, Aurora, Colorado.
J Emerg Med. 2017 Jul;53(1):1-9. doi: 10.1016/j.jemermed.2017.03.024. Epub 2017 Apr 19.
The co-administration of ketamine and propofol (CoKP) is thought to maximize the beneficial profile of each medication, while minimizing the respective adverse effects of each medication.
Our objective was to compare adverse events between ketamine monotherapy (KM) and CoKP for procedural sedation and analgesia (PSA) in a pediatric emergency department (ED).
This was a prospective, randomized, single-blinded, controlled trial of KM vs. CoKP in patients between 3 and 21 years of age. The attending physician administered either ketamine 1 mg/kg i.v. or ketamine 0.5 mg/kg and propofol 0.5 mg/kg i.v. The physician could administer up to three additional doses of ketamine (0.5 mg/kg/dose) or ketamine/propofol (0.25 mg/kg/dose of each). Adverse events (e.g., respiratory events, cardiovascular events, unpleasant emergence reactions) were recorded. Secondary outcomes included efficacy, recovery time, and satisfaction scores.
Ninety-six patients were randomized to KM and 87 patients were randomized to CoKP. There was no difference in adverse events or type of adverse event, except nausea was more common in the KM group. Efficacy of PSA was higher in the KM group (99%) compared to the CoKP group (90%). Median recovery time was the same. Satisfaction scores by providers, including nurses, were higher for KM, although parents were equally satisfied with both sedation regimens.
We found no significant differences in adverse events between the KM and CoKP groups. While CoKP is a reasonable choice for pediatric PSA, our study did not demonstrate an advantage of this combination over KM.
氯胺酮与丙泊酚联合使用（CoKP）被认为可使每种药物的有益特性最大化，同时将每种药物各自的不良反应最小化。
我们的目的是比较氯胺酮单一疗法（KM）和CoKP用于儿科急诊科（ED）程序性镇静和镇痛（PSA）时的不良事件。
这是一项针对3至21岁患者的KM与CoKP的前瞻性、随机、单盲、对照试验。主治医生静脉注射氯胺酮1mg/kg或氯胺酮0.5mg/kg加丙泊酚0.5mg/kg。医生可额外最多注射三剂氯胺酮（0.5mg/kg/剂）或氯胺酮/丙泊酚（各0.25mg/kg/剂）。记录不良事件（如呼吸事件、心血管事件、不愉快的苏醒反应）。次要结局包括疗效、恢复时间和满意度评分。
96例患者被随机分配至KM组，87例患者被随机分配至CoKP组。不良事件或不良事件类型无差异，只是恶心在KM组更常见。KM组PSA的疗效（99%）高于CoKP组（90%）。中位恢复时间相同。包括护士在内的医护人员对KM的满意度评分更高，尽管家长对两种镇静方案同样满意。
我们发现KM组和CoKP组在不良事件方面无显著差异。虽然CoKP是儿科PSA的合理选择，但我们的研究未证明这种联合用药比KM有优势。
