Stevic Marija, Ristic Nina, Budic Ivana, Ladjevic Nebojsa, Trifunovic Branislav, Rakic Ivan, Majstorovic Marko, Burazor Ivana, Simic Dusica
Department of Anesthesia, Medical Faculty University of Belgrade, Belgrade, Serbia.
Department of Gastroenterology, University Children's Hospital, Belgrade, Serbia.
Lasers Med Sci. 2017 Sep;32(7):1525-1533. doi: 10.1007/s10103-017-2275-x. Epub 2017 Jul 12.
The aim of our study was to research and evaluate cardiovascular and respiratory stability, clinical efficacy, and safety of two different anesthetic agents in pediatric patients who underwent Pulse dye (wavelength 595 nm, pulse duration 0-40 ms, power 0-40 J) and CO (wavelength 10,600 nm, intensity-fraxel mod with SX index 4 to 8, power 0-30 W) laser procedure. This prospective non-blinded study included 203 pediatric patients ASA I-II, aged between 1 month and 12 years who underwent short-term procedural sedation and analgesia for the laser procedure. After oral premedication with midazolam, 103 children were analgo-sedated with ketamine and fentanyl (K group) and 100 with ketofol and fentanyl (KT group). Vital signs, applied drug doses, pulse oximetry, and parental satisfaction questionnaire were used to compare these two groups. Statistical differences were tested using Student's t test, Mann-Whitney U test, chi-square test, and Fisher's exact test. Receiver operating characteristic (ROC) curve analysis was used to assess the cut-off value of the duration of anesthesia predicting apnea. Tachycardia was recorded in a significantly higher number of patients who received ketamine as the anesthetic agent (35.9 vs. 3% respectively). Hypertension was also significantly more frequent in patients who received ketamine in comparison with patients who received ketofol (25.2 vs. 3%). Laryngospasm was not observed in both examined groups. There was no statistically significant difference between groups in satisfaction of parents and doctors. Apnea and respiratory depression occurred significantly more frequent in ketofol than in ketamine group (12 vs. 0.97% and 13 vs. 0%). Based on ROC analysis for apnea, we found a significantly higher number of patients with apnea in the ketofol group when duration of anesthesia was longer than 17 min. Our study has shown that ketofol is more comfortable than ketamine in short-term laser procedures in children, causing less hemodynamic alteration with mild respiratory depression and less post-procedural adverse events.
我们研究的目的是研究和评估两种不同麻醉剂在接受脉冲染料（波长595nm，脉冲持续时间0 - 40ms，功率0 - 40J）和CO（波长10600nm，强度 - 飞点模式，SX指数4至8，功率0 - 30W）激光手术的儿科患者中的心血管和呼吸稳定性、临床疗效及安全性。这项前瞻性非盲研究纳入了203例ASA I - II级、年龄在1个月至12岁之间的儿科患者，他们接受了用于激光手术的短期程序镇静和镇痛。在口服咪达唑仑进行术前用药后，103名儿童采用氯胺酮和芬太尼进行镇痛镇静（K组），100名儿童采用氯胺酮 - 丙泊酚和芬太尼进行镇痛镇静（KT组）。通过生命体征、所用药物剂量、脉搏血氧饱和度及家长满意度调查问卷对两组进行比较。使用学生t检验、曼 - 惠特尼U检验、卡方检验和费舍尔精确检验来检验统计学差异。采用受试者工作特征（ROC）曲线分析来评估预测呼吸暂停的麻醉持续时间的临界值。接受氯胺酮作为麻醉剂的患者中记录到心动过速的人数显著更多（分别为35.9%和3%）。与接受氯胺酮 - 丙泊酚的患者相比，接受氯胺酮的患者高血压也明显更常见（25.2%和3%）。在两个研究组中均未观察到喉痉挛。家长和医生的满意度在两组之间无统计学显著差异。氯胺酮 - 丙泊酚组呼吸暂停和呼吸抑制的发生率明显高于氯胺酮组（分别为12%和0.97%，13%和0%）。基于呼吸暂停的ROC分析，我们发现当麻醉持续时间超过17分钟时，氯胺酮 - 丙泊酚组呼吸暂停患者的数量显著更多。我们的研究表明，在儿童短期激光手术中，氯胺酮 - 丙泊酚比氯胺酮更舒适，引起的血流动力学改变更小，伴有轻度呼吸抑制且术后不良事件更少。
