Rogerson Colin M, Abulebda Kamal, Hobson Michael J
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana; and.
Division of Pediatric Critical Care Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
Hosp Pediatr. 2017 Sep;7(9):542-546. doi: 10.1542/hpeds.2016-0191. Epub 2017 Aug 10.
Obesity increases the risk of complications during pediatric procedural sedation. The risk of being underweight has not been evaluated in this arena. We therefore investigated the association of BMI with sedation dosing and adverse events in children across a range of BMIs.
A total of 1976 patients ages 2 to 21 years old with oncologic diagnoses underwent lumbar punctures and/or bone marrow aspirations. All children received a standard adjunctive dose of ketamine before sedation with propofol. Weight categories were stratified by BMI percentile: underweight <5%, normal weight 5% to 85%, overweight >85%, and obese >95%. Dosing and adverse events (hypoxia, apnea, bradycardia, or hypotension) were reviewed.
There were no differences in propofol dosing for procedural sedation between patients who were normal weight and underweight. However, children who were overweight and those who were obese used less propofol compared with children who were normal weight ( < .01). Children who were underweight had a higher proportion of adverse events overall relative to those children of normal weight ( < .001). In contrast, there was not an increase in adverse events for patients who were overweight and obese.
Children who are overweight and children with obesity who require deep sedation can undergo successful sedation with lower propofol dosing relative to children of a normal weight. This dosing strategy may help to mitigate the risks associated with sedating patients who are obese. Notably, children who were underweight had an increased rate of complications despite receiving an equal amount of sedation compared with patients who were normal weight. This should alert the clinicians to the risks associated with sedating children who are underweight.
肥胖会增加儿科程序性镇静期间并发症的风险。体重过轻的风险在这一领域尚未得到评估。因此，我们研究了一系列BMI范围内儿童的BMI与镇静剂量及不良事件之间的关联。
共有1976例年龄在2至21岁的肿瘤诊断患者接受了腰椎穿刺和/或骨髓穿刺。所有儿童在使用丙泊酚镇静前均接受标准剂量的氯胺酮辅助用药。体重类别根据BMI百分位数分层：体重过轻＜5%，正常体重5%至85%，超重＞85%，肥胖＞95%。对用药剂量和不良事件（低氧、呼吸暂停、心动过缓或低血压）进行了回顾。
正常体重和体重过轻的患者在程序性镇静时丙泊酚的用药剂量没有差异。然而，与正常体重的儿童相比，超重和肥胖的儿童使用的丙泊酚较少（P＜0.01）。总体而言，体重过轻的儿童相对于正常体重的儿童不良事件发生率更高（P＜0.001）。相比之下，超重和肥胖患者的不良事件并未增加。
与正常体重的儿童相比，超重和肥胖且需要深度镇静的儿童使用较低剂量的丙泊酚即可成功完成镇静。这种给药策略可能有助于降低肥胖患者镇静相关的风险。值得注意的是，尽管体重过轻的儿童与正常体重的患者接受的镇静剂量相同，但其并发症发生率却更高。这应提醒临床医生注意体重过轻儿童镇静的相关风险。
