Lam Samuel H F, Li David R, Hong Christian E, Vilke Gary M
Department of Emergency Medicine, University of California, San Diego, San Diego, California.
J Emerg Med. 2018 Jul;55(1):51-63. doi: 10.1016/j.jemermed.2018.04.025. Epub 2018 May 24.
Per rectum (PR) medication delivery is an alternative to traditional oral (PO), intravenous (IV), or intramuscular (IM) administration of medication for procedural sedation of pediatric emergency department patients. However, many emergency physicians are unfamiliar with its use, and there are no widely adopted guidelines or reviews dedicated to this topic.
Our aim was to provide emergency physicians with an overview of PR procedural sedation medications in pediatric patients.
We performed a PubMed literature search of relevant keywords limited to studies of human subjects published in English between January 1, 1990 and December 31, 2017. We excluded case reports, general review articles, editorial/opinion pieces, correspondence, and abstracts. Two of the authors then conducted a structured review of the selected studies.
A total of 315 PubMed citations meeting the search criteria were found. Twenty-eight articles were included for final detailed review. Only 4 of the 28 included studies were conducted in the emergency department setting. A total of 9 different medications have been studied for PR procedural sedation. Sedation effectiveness ranged from 40% to 98%. No life-threatening complications were reported in any of the included clinical trials. Hypoxia was found to occur in up to 10% of those receiving PR sedation.
Pediatric procedural sedation with PR medications appears to be feasible, moderately effective, and safe based on our review of the current literature. However, further studies on its applicability in the emergency department setting are needed.
对于儿科急诊科患者的程序性镇静，经直肠给药是传统口服、静脉或肌肉注射给药的一种替代方式。然而，许多急诊医生并不熟悉其用法，且尚无专门针对该主题的广泛采用的指南或综述。
我们的目的是为急诊医生提供儿科患者经直肠程序性镇静药物的概述。
我们在PubMed上对相关关键词进行文献检索，检索范围限于1990年1月1日至2017年12月31日期间以英文发表的人体研究。我们排除了病例报告、一般综述文章、社论/观点文章、通信和摘要。然后，两位作者对所选研究进行了结构化综述。
共找到315篇符合检索标准的PubMed引文。28篇文章被纳入最终详细综述。28项纳入研究中只有4项是在急诊科环境中进行的。共有9种不同药物被研究用于经直肠程序性镇静。镇静有效率在40%至98%之间。纳入的任何临床试验均未报告危及生命的并发症。发现接受经直肠镇静的患者中高达10%会出现低氧血症。
根据我们对当前文献的综述，儿科经直肠药物程序性镇静似乎是可行的、中度有效的且安全的。然而，需要进一步研究其在急诊科环境中的适用性。
