Schmitz Achim, Weiss Markus, Kellenberger Christian, O'Gorman Tuura Ruth, Klaghofer Richard, Scheer Ianina, Makki Malek, Sabandal Carola, Buehler Philipp Karl
Department of Anesthesiology, University Children's Hospital, Zurich, Switzerland.
Children's Research Center, University Children's Hospital, Zurich, Switzerland.
Paediatr Anaesth. 2018 Mar;28(3):264-274. doi: 10.1111/pan.13315. Epub 2018 Jan 27.
Deep sedation using propofol has become a standard technique in children. This double-blinded randomized clinical trial aims to compare the clinical effects of propofol-mono-sedation vs a combination of propofol and ketamine at induction and a reduced propofol infusion rate for maintenance in children undergoing diagnostic magnetic resonance imaging.
Children aged from 3 months to 10 years scheduled as outpatients for elective magnetic resonance imaging with deep sedation were included. They were randomized into 2 groups, receiving either 1 mg/kg ketamine at induction, then a propofol infusion rate of 5 mg/kg/h or a propofol infusion rate of 10 mg/kg/h without prior ketamine. Time to full recovery (modified Aldrete score = 10) was the primary outcome. Further outcomes were quality of induction, immobilization during image acquisition, recovery, postoperative nausea and vomiting, emergence delirium using the Pediatric Anesthesia Emergence Delirium scale, vital signs and adverse cardiorespiratory events. All patients and parents as well as anesthetists, imaging technicians, and postsedation personnel were blinded. Data are given as median (range).
In total, 347 children aged 4.0 (0.25-10.9) years, weighing 15.6 (5.3-54) kg, ASA classification I, II, or III (141/188/18) were included. The ketamine-propofol group showed significantly shorter recovery times (38 (22-65) vs 54 (37-77) minutes; median difference 14 (95% CI: 8, 20) minutes; P < .001), better quality of induction, and higher blood pressure, but higher incidence of movement requiring additional sedative drugs. There were no significant differences in respiratory side effects, cardiovascular compromise, emergence delirium, or postoperative nausea and vomiting.
Both sedation concepts proved to be reliable with a low incidence of side effects. Ketamine at induction with a reduced propofol infusion rate leads to faster postanesthetic recovery.
使用丙泊酚进行深度镇静已成为儿童的标准技术。这项双盲随机临床试验旨在比较丙泊酚单一镇静与丙泊酚和氯胺酮联合使用在诱导时以及降低丙泊酚输注速率以维持接受诊断性磁共振成像的儿童镇静效果。
纳入计划作为门诊患者接受深度镇静的选择性磁共振成像的3个月至10岁儿童。他们被随机分为2组，一组在诱导时接受1mg/kg氯胺酮，然后丙泊酚输注速率为5mg/kg/h，另一组在没有预先使用氯胺酮的情况下丙泊酚输注速率为10mg/kg/h。完全恢复时间（改良Aldrete评分为10分）是主要结局。进一步的结局包括诱导质量、图像采集期间的制动情况、恢复情况、术后恶心和呕吐、使用小儿麻醉苏醒谵妄量表评估的苏醒谵妄、生命体征和不良心肺事件。所有患者及其家长以及麻醉医生、影像技术人员和镇静后护理人员均不知情。数据以中位数（范围）表示。
总共纳入了347名年龄为4.0（0.25 - 10.9）岁、体重为15.6（5.3 - 54）kg、ASA分级为I、II或III（141/188/18）的儿童。氯胺酮 - 丙泊酚组的恢复时间明显更短（38（22 - 65）分钟对54（37 - 77）分钟；中位数差异14（95%CI：8，20）分钟；P <.001），诱导质量更好，血压更高，但需要额外使用镇静药物的活动发生率更高。在呼吸副作用、心血管功能障碍、苏醒谵妄或术后恶心和呕吐方面没有显著差异。
两种镇静方案均被证明可靠，副作用发生率低。诱导时使用氯胺酮并降低丙泊酚输注速率可导致麻醉后恢复更快。
