Williams John Matthew, Schuman Sarah, Regen Rebecca, Berg Allyson, Stuart Lindsay, Raju Jampana, Mabry William, Kink Rudy John
From the Division of Pediatric Emergency Medicine, Department of Pediatrics, Le Bonheur Children's Hospital.
Department of Clinical Pharmacy, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
Pediatr Emerg Care. 2020 Sep;36(9):e494-e499. doi: 10.1097/PEC.0000000000001782.
Intranasal fentanyl and midazolam use is increasing in the acute care setting for analgesia and anxiolysis, but there is a lack of literature demonstrating their use, alone or in combination, at pediatric urgent care centers.
This retrospective study investigated intranasal fentanyl and midazolam use at an urgent care center located within Le Bonheur Children's Hospital and 2 affiliated off-site centers from September 22, 2011, to December 30, 2015. Data collected included patient demographics, initial fentanyl dose, initial midazolam dose, type of procedure, and serious adverse drug reactions.
Of the 490 patients who met the inclusion criteria, 143 patients received intranasal fentanyl alone, 92 received intranasal midazolam alone, and 255 received fentanyl in combination with midazolam. The overall patient population was 50% male with a median (range) age of 4.5 (0.2-17.9) years, and most patients were black at 57.1%. The median (range) initial intranasal fentanyl dose was 2.02 (0.99-4.22) μg/kg, and the median initial (range) intranasal midazolam dose was 0.19 (0.07-0.42) mg/kg. In cases where fentanyl and midazolam were administered in combination, the median (range) initial fentanyl dose was 2.23 (0.6-4.98) μg/kg and median (range) initial midazolam dose was 0.2 (0.03-0.45) mg/kg. There were no serious adverse drug reactions reported.
Intranasal fentanyl and midazolam when administrated alone and in combination can provide analgesia and anxiolysis for minor procedures in pediatric patients treated in the urgent care setting.
在急性护理环境中，鼻内使用芬太尼和咪达唑仑以进行镇痛和抗焦虑治疗的情况日益增多，但缺乏关于它们在儿科紧急护理中心单独使用或联合使用的文献。
这项回顾性研究调查了2011年9月22日至2015年12月30日期间，在勒邦赫尔儿童医院内的一家紧急护理中心以及2个附属的院外中心使用鼻内芬太尼和咪达唑仑的情况。收集的数据包括患者人口统计学信息、初始芬太尼剂量、初始咪达唑仑剂量、操作类型以及严重药物不良反应。
在符合纳入标准的490名患者中，143名患者仅接受了鼻内芬太尼治疗，92名患者仅接受了鼻内咪达唑仑治疗，255名患者接受了芬太尼与咪达唑仑联合治疗。总体患者群体中50%为男性，年龄中位数（范围）为4.5（0.2 - 17.9）岁，大多数患者为黑人，占57.1%。鼻内芬太尼初始剂量中位数（范围）为2.02（0.99 - 4.22）μg/kg，鼻内咪达唑仑初始剂量中位数（范围）为0.19（0.07 - 0.42）mg/kg。在芬太尼和咪达唑仑联合使用的情况下，芬太尼初始剂量中位数（范围）为2.23（0.6 - 4.98）μg/kg，咪达唑仑初始剂量中位数（范围）为0.2（0.03 - 0.45）mg/kg。未报告严重药物不良反应。
鼻内芬太尼和咪达唑仑单独使用或联合使用时，可为儿科紧急护理环境中接受小手术的患者提供镇痛和抗焦虑作用。
