van de Bunt Jascha A, Veldhoen Esther S, Nievelstein Rutger A J, Hulsker Caroline C C, Schouten Antonius N J, van Herwaarden Maud Y A
Department of Pediatric Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Pediatric Intensive Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
Paediatr Anaesth. 2017 Nov;27(11):1091-1097. doi: 10.1111/pan.13226. Epub 2017 Sep 20.
Hydrostatic or pneumatic reduction of intussusception is an invasive procedure that is stressful and may be painful for a child. Resistance of the child may increase the duration of the procedure and decrease success rate of reduction. Analgesia can help to reduce pain, but not necessarily resistance. General anesthesia increases success rate of reduction. However, it requires the presence of an anesthesiologist, and may lead to anesthesia-related complications. Procedural sedation with esketamine could be a safe alternative.
The aim of this study was to compare hydrostatic reduction using morphine analgesia compared to procedural sedation with esketamine in terms of success rate, adverse events, and duration of reduction.
A retrospective case-cohort comparison study was performed with two groups of patients who had undergone hydrostatic reduction for ileocolic intussusception and received morphine analgesia (n = 37) or esketamine sedation (n = 20). Until July 2013, reduction was performed after intravenously administered morphine. Hereafter, a new protocol for procedural sedation was implemented and reduction was performed after administration of esketamine. Cases were matched for age and duration of symptoms.
No adverse events requiring intervention other than administration of oxygen were reported for either group. Success rate of reduction using esketamine sedation was 90% vs 70% using morphine analgesia, risk ratio (RR) 1.29, 95% CI[0.93-1.77]. Recurrence rate using esketamine sedation was 10% vs 15% using morphine analgesia, RR 0.67, 95% CI[0.12-3.57]. Reduction time was shorter using esketamine sedation (Median 5 minutes, IQR 9 minutes) vs morphine analgesia (Median 8 minutes, IQR 16 minutes, P = .04, Median difference 3, 95% CI[-1.50-8.75]). Median hospital stay in the esketamine group was 1.5 days (IQR 1.8) vs 2 days (IQR 5.3) in the morphine group.
No serious adverse events were recorded. In comparison to morphine analgesia, with esketamine there was weak evidence for a higher success rate, lower recurrence rate, shorter duration, and shorter length of hospital stay.
肠套叠的水压复位或气灌肠复位是一种侵入性操作，对儿童来说有压力且可能会疼痛。儿童的抵抗可能会增加操作时间并降低复位成功率。镇痛有助于减轻疼痛，但不一定能降低抵抗。全身麻醉可提高复位成功率。然而，这需要麻醉医生在场，且可能会导致与麻醉相关的并发症。使用艾司氯胺酮进行程序性镇静可能是一种安全的替代方法。
本研究的目的是比较使用吗啡镇痛的水压复位与使用艾司氯胺酮进行程序性镇静在成功率、不良事件和复位持续时间方面的差异。
进行了一项回顾性病例队列对照研究，两组接受回结肠套叠水压复位并分别接受吗啡镇痛（n = 37）或艾司氯胺酮镇静（n = 20）的患者纳入研究。在2013年7月之前，在静脉注射吗啡后进行复位。此后，实施了一种新的程序性镇静方案，在给予艾司氯胺酮后进行复位。病例根据年龄和症状持续时间进行匹配。
两组均未报告除吸氧外需要干预的不良事件。使用艾司氯胺酮镇静的复位成功率为90%，而使用吗啡镇痛的为70%，风险比（RR）为1.29，95%可信区间[0.93 - 1.77]。使用艾司氯胺酮镇静的复发率为10%，而使用吗啡镇痛的为15%，RR为0.67，95%可信区间[0.12 - 3.57]。使用艾司氯胺酮镇静的复位时间较短（中位数5分钟，四分位数间距9分钟），而吗啡镇痛组为（中位数8分钟，四分位数间距16分钟，P = 0.04，中位数差异3，95%可信区间[-1.50 - 8.75]）。艾司氯胺酮组的中位住院时间为1.5天（四分位数间距1.8），而吗啡组为2天（四分位数间距5.3）。
未记录到严重不良事件。与吗啡镇痛相比，使用艾司氯胺酮有较弱的证据表明成功率更高、复发率更低、持续时间更短且住院时间更短。
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