Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
Anesthesiology Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates.
Curr Opin Anaesthesiol. 2020 Aug;33(4):533-538. doi: 10.1097/ACO.0000000000000885.
The present review provides an overview of the different fields of procedural sedation and analgesia (PSA), describing the evidence from recently published studies concerning anxiety and moderate pain, cardiac interventions, gastrointestinal interventions, and PSA use in infants. It also provides guidance for practitioners of both unscheduled and scheduled procedural sedation, and a summary of the current guideline for PSA.
Safety always has to be first priority. Recently published literature is focusing on the combination of different well established drugs such as dexmedetomidine, remifentanil, propofol, and ketamine. These traditional and well known drugs are commonly used for PSA. The combinational use of multiple drugs seems to have benefits for both the provider and patient. Furthermore, there is growing interest into specific protocols and adaption for special circumstances. The preferred medications used for PSA should be both effective and well tolerated.
Procedural sedation deserves to have high degree of attention for potential adverse events. New combinations of well established drugs provide a better pharmacokinetic profile, fit to different indications and offer multiple benefits for both provider and patient.
本文综述了不同领域的程序镇静和镇痛（PSA），描述了最近发表的关于焦虑和中度疼痛、心脏介入、胃肠道介入以及 PSA 在婴儿中的应用的研究证据。它还为非计划性和计划性 PSA 从业者提供了指导，并总结了目前 PSA 的指南。
安全性始终是首要任务。最近发表的文献侧重于将多种已确立的药物（如右美托咪定、瑞芬太尼、丙泊酚和氯胺酮）联合使用。这些传统且广为人知的药物通常用于 PSA。多种药物的联合使用似乎对提供者和患者都有好处。此外，人们对特殊情况下的特定方案和适应越来越感兴趣。PSA 中使用的首选药物应该既有效又耐受良好。
程序镇静值得高度关注潜在的不良事件。已确立药物的新组合提供了更好的药代动力学特征，适用于不同的适应症，并为提供者和患者带来多种益处。
