Tervonen Miikka, Pokka Tytti, Kallio Merja, Peltoniemi Outi
Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland.
PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu, Oulu, Finland.
Acta Paediatr. 2020 Oct;109(10):2008-2016. doi: 10.1111/apa.15348. Epub 2020 May 28.
This systematic review and meta-analysis evaluated the effectiveness of intranasal dexmedetomidine as a sole sedative during paediatric procedural sedation outside the operating room.
Relevant literature identified by PubMed, Scopus, ClinicalTrials.gov, ScienceDirect and Cochrane Library up to 31 December 2019 was systematically reviewed. Randomised controlled trials that compared intranasal dexmedetomidine with another sedative or placebo during paediatric procedural sedation were included. Trials that studied intranasal dexmedetomidine as a premedication before anaesthesia were excluded. The primary outcome was the success of the planned procedure.
We analysed seven randomised controlled trials of 730 patients: four trials with 570 patients compared dexmedetomidine with chloral hydrate and three trials with 160 patients compared dexmedetomidine with midazolam. The incidence of successfully completing the procedure did not differ between dexmedetomidine and chloral hydrate, but dexmedetomidine had a higher success rate than midazolam. The incidence of hypotension, bradycardia or respiratory complications did not differ between the sedatives used. Nausea and vomiting were more common in children treated with chloral hydrate than in those treated with other sedatives.
Intranasal dexmedetomidine was a safe and effective sedative for minor paediatric procedures.
本系统评价和荟萃分析评估了在手术室以外的儿科程序镇静中，鼻内给予右美托咪定作为单一镇静剂的有效性。
对截至2019年12月31日通过PubMed、Scopus、ClinicalTrials.gov、ScienceDirect和Cochrane图书馆检索到的相关文献进行系统评价。纳入了在儿科程序镇静期间将鼻内右美托咪定与另一种镇静剂或安慰剂进行比较的随机对照试验。排除了研究鼻内右美托咪定作为麻醉前用药的试验。主要结局是计划手术的成功。
我们分析了7项随机对照试验，共730例患者：4项试验共570例患者将右美托咪定与水合氯醛进行比较，3项试验共160例患者将右美托咪定与咪达唑仑进行比较。右美托咪定与水合氯醛之间成功完成手术的发生率无差异，但右美托咪定的成功率高于咪达唑仑。所用镇静剂之间低血压、心动过缓或呼吸并发症的发生率无差异。水合氯醛治疗的儿童恶心和呕吐比其他镇静剂治疗的儿童更常见。
鼻内右美托咪定是小儿小手术安全有效的镇静剂。
