Indiana University School of Medicine, Indianapolis, IN.
Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
PM R. 2019 Dec;11(12):1320-1325. doi: 10.1002/pmrj.12146. Epub 2019 May 6.
Pediatric patients with cerebral palsy often undergo intramuscular botulinum toxin (BoNT-A) injections. These injections can be painful and may require procedural sedation. An ideal sedation protocol has yet to be elucidated.
To investigate the safety and efficacy of a propofol and ketamine based sedation protocol in pediatric patients with cerebral palsy requiring BoNT-A injections.
Retrospective chart review.
The sedations took place in a procedural sedation suite at a tertiary children's hospital from February 2013 through September 2017.
164 patients with diagnoses of cerebral palsy undergoing propofol and ketamine based sedation for injections with botulinum toxin A.
An initial bolus of 0.5 mg/kg ketamine followed by a 2 mg/kg bolus of propofol was administered with supplemental boluses of propofol as needed to achieve deep sedation during the intramuscular BoNT-A injections.
Propofol dosages, adverse events, serious adverse events, and sedation time parameters were reviewed.
345 sedations were successfully performed on 164 patients. The median total dose of propofol was 4.7 mg/kg (interquartile range [IQR]: 3.5, 6.3). Adverse events were encountered in 10.1% of procedures including hypoxemia responsive to supplemental oxygen (9.6%) and transient apnea (1.4%). The mean procedure time, recovery time, and total sedation time were 10, 11 and 33 minutes, respectively. With regard to patient variables, including age, weight, dose of propofol, sedation time, and Gross Motor Function Classification System classification, there was no association with increased incidence of adverse events.
Our sedation protocol of propofol and ketamine is safe and effective in children with cerebral palsy undergoing procedural sedation for intramuscular injections with BoNT-A. The adverse events encountered appeared to be related to airway and respiratory complications secondary to musculoskeletal deformities, emphasizing the importance of airway monitoring and management in these patients.
IV.
脑瘫患儿常需接受肌肉内肉毒毒素（BoNT-A）注射，该操作可能引起疼痛，需行镇静。但目前尚无理想的镇静方案。
评估丙泊酚联合氯胺酮镇静方案在脑瘫患儿 BoNT-A 注射中的安全性和有效性。
回顾性病历研究。
该研究于 2013 年 2 月至 2017 年 9 月在一家三级儿童医院的镇静室进行。
164 例脑瘫患儿，因 BoNT-A 注射行丙泊酚联合氯胺酮镇静。
首先给予患儿 0.5mg/kg 氯胺酮，继以 2mg/kg 丙泊酚，必要时追加丙泊酚以达到深镇静，完成肌肉内 BoNT-A 注射。
评估丙泊酚剂量、不良事件、严重不良事件和镇静时间参数。
164 例患儿共完成 345 次镇静。丙泊酚总剂量中位数为 4.7mg/kg（四分位距：3.5，6.3）。10.1%的操作中出现不良事件，包括需吸氧纠正的低氧血症（9.6%）和短暂性呼吸暂停（1.4%）。平均操作时间、苏醒时间和总镇静时间分别为 10、11 和 33min。患儿年龄、体重、丙泊酚剂量、镇静时间、粗大运动功能分级系统（GMFCS）分级等变量与不良事件发生率无相关性。
丙泊酚联合氯胺酮镇静方案用于脑瘫患儿 BoNT-A 注射，安全有效。不良事件似乎与肌肉骨骼畸形导致的气道和呼吸并发症有关，强调了此类患儿气道监测和管理的重要性。
回顾性研究。
IV。
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