Rosenbloom Julia M, Senthil Kumaran, Long Alexander S, Robinson Whitney R, Peeples Kenneth N, Fiadjoe John E, Litman Ronald S
Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Paediatr Anaesth. 2017 Nov;27(11):1142-1147. doi: 10.1111/pan.13217. Epub 2017 Aug 10.
Although it is known that a patient's race may influence their medical care, racial patterns of medication administration in pediatric anesthesia have not been well-studied. The aim of this study was to determine if differences exist between Black and White children with regard to administration of anesthetic and analgesic medications for a single procedure at our institution.
We conducted a retrospective review of medications administered to patients for emergency appendectomies at a large academic children's hospital from 2010 to 2015. We examined the association between patient race and administration of preoperative midazolam and intraoperative ondansetron, lidocaine, ketorolac, and weight-based doses of fentanyl and morphine.
During the study period, 1680 patients (1329 White, 351 Black) underwent emergency appendectomy. There were no significant racial differences in administration of intraoperative anesthetic medications between Black and White children. In unadjusted analysis, Black children were less likely to receive preoperative midazolam than White children (OR=0.74 [95% CI, 0.58-0.94], P=.012). After adjusting for confounders, there was no evidence of racial differences in administration of preoperative or intraoperative medications.
We did not find a significant difference in preoperative or intraoperative medication administration based on race when we adjusted for age, gender, and attending anesthesiologist practice patterns. We encourage all institutions to monitor their own practice patterns with regard to race.
尽管已知患者的种族可能会影响其医疗护理，但儿科麻醉中药物给药的种族模式尚未得到充分研究。本研究的目的是确定在我们机构中，黑人儿童和白人儿童在进行单一手术时使用麻醉和镇痛药物方面是否存在差异。
我们对2010年至2015年在一家大型学术儿童医院接受急诊阑尾切除术的患者所使用的药物进行了回顾性研究。我们研究了患者种族与术前咪达唑仑以及术中昂丹司琼、利多卡因、酮咯酸和按体重计算剂量的芬太尼及吗啡给药之间的关联。
在研究期间，1680例患者（1329例白人，351例黑人）接受了急诊阑尾切除术。黑人儿童和白人儿童在术中麻醉药物给药方面没有显著的种族差异。在未经调整的分析中，黑人儿童比白人儿童接受术前咪达唑仑的可能性更小（比值比=0.74 [95%置信区间，0.58 - 0.94]，P = 0.012）。在对混杂因素进行调整后，没有证据表明术前或术中药物给药存在种族差异。
在对年龄、性别和主治麻醉医生的执业模式进行调整后，我们没有发现基于种族的术前或术中药物给药存在显著差异。我们鼓励所有机构监测自身在种族方面的执业模式。
