Schacherer Nicole M, Armstrong Tamara, Perkins Amy M, Poirier Michael P, Schmidt James M
From the Department of Pediatric Emergency Medicine, Children's Hospital of The King's Daughters, Norfolk, Virginia, the Department of Emergency Medicine Residency, Maricopa Medical Center, Phoenix, Arizona, and the Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
South Med J. 2019 May;112(5):277-282. doi: 10.14423/SMJ.0000000000000973.
Frequently, infants and children require sedation to facilitate noninvasive procedures and imaging studies. Propofol and dexmedetomidine are used to achieve deep procedural sedation in children. The objective of this study was to compare the clinical safety and efficacy of propofol versus dexmedetomidine in pediatric patients undergoing sedation in a pediatric sedation unit.
A retrospective analysis of patients sedated with either propofol or dexmedetomidine in a pediatric sedation unit by pediatric emergency physicians was performed. Both medications were dosed per protocol with propofol 2 mg/kg induction and 150 μg · kg · min maintenance and dexmedetomidine 3 μg/kg induction for 10 minutes and 2 μg · kg · hmaintenance. The variables collected included drug dose, sedation time (time that the drug was given to the completion of the procedure), recovery time (end of the study to the return to the presedation sedation score for 15 minutes), need for dose rate changes, airway management, and adverse events.
A total of 2432 children were included- 1503 who received propofol and 929 who received dexmedetomidine. Propofol and dexmedetomidine resulted in successful completion of the study in 98.8% and 99.7%, respectively ( = 0.02). The mean recovery time for propofol was 34.3 minutes, compared with 65.6 minutes for dexmedetomidine ( < 0.001). The need for unexpected airway management was 9.7% for propofol and 2.2% for dexmedetomidine ( < 0.001). Adverse events occurred in 8.6% and 6% of patients in the propofol and dexmedetomidine groups, respectively ( = 0.02).
Propofol use led to significantly shorter recovery times, with an increased need for airway management, but rates of bag-mask ventilation (2.3%), airway obstruction (1.1%), and desaturation (1.6%) were low. No patients required intubation. Propofol is a reasonable alternative to dexmedetomidine, with a clinically acceptable safety profile.
婴幼儿和儿童常常需要镇静来辅助无创操作和影像学检查。丙泊酚和右美托咪定用于实现儿童深度操作镇静。本研究的目的是比较丙泊酚与右美托咪定在儿科镇静单元接受镇静的儿科患者中的临床安全性和有效性。
对儿科急诊医生在儿科镇静单元使用丙泊酚或右美托咪定进行镇静的患者进行回顾性分析。两种药物均按方案给药，丙泊酚诱导剂量为2mg/kg，维持剂量为150μg·kg·min，右美托咪定诱导剂量为3μg/kg，持续10分钟，维持剂量为2μg·kg·h。收集的变量包括药物剂量、镇静时间（给药至操作完成的时间）、恢复时间（研究结束至恢复到镇静前镇静评分达15分钟的时间）、剂量率调整需求、气道管理及不良事件。
共纳入243名儿童，其中150名接受丙泊酚，93名接受右美托咪定。丙泊酚和右美托咪定分别使98.8%和99.7%的研究成功完成（P = 0.02）。丙泊酚的平均恢复时间为34.3分钟，而右美托咪定为65.6分钟（P < 0.001）。丙泊酚意外气道管理需求为9.7%，右美托咪定为2.2%（P < 0.001）。丙泊酚组和右美托咪定组不良事件发生率分别为8.6%和6%（P = 0.02）。
使用丙泊酚导致恢复时间显著缩短，气道管理需求增加，但面罩通气率（2.3%）、气道梗阻率（1.1%）和血氧饱和度降低率（1.6%）较低。无患者需要插管。丙泊酚是右美托咪定的合理替代药物，具有临床可接受的安全性。
