Sirimontakan Thitima, Artprom Ninuma, Anantasit Nattachai
Department of Pediatrics, Ramathibodi Hospital, Mahidol University, 10400, Bangkok, Thailand.
Department of Nursing, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Anesth Pain Med. 2020 Aug 26;10(4):e106493. doi: 10.5812/aapm.106493. eCollection 2020 Aug.
The volume of pediatric Procedural Sedation and Analgesia (PSA) outside the operating room has been increasing. This high clinical demand leads non-anesthesiologists, especially pediatric intensivists, pediatricians, and emergency physicians, to take a role in performing procedural sedation. Our department has established the PSA service by pediatric intensivists since 2015.
We aimed to assess the efficacy and safety of PSA outside the operating room conducted by pediatric intensivists and identify risk factors for severe adverse events.
This was a retrospective descriptive study conducted from January 2015 to July 2019. Children aged less than 20 years who underwent procedural sedation were included. We collected demographic data, sedative and analgesic medications, American Society of Anesthesiologists (ASA) Physical Status Classification, indications for sedation, the success of procedural sedation, and any adverse events.
Altogether, 395 patients with 561 procedural sedation cases were included. The median age was 55 months (range: 15 to 119 months), and 58.5% (231/395) were male. The rate of successful procedures under PSA was 99.3%. Serious Adverse Events (SAE) occurred in 2.7%. Patients who received more than three sedative medications had higher SAE than patients who received fewer medications (adjusted for age, location of sedation, type of procedure, and ASA classification) (odds ratio: 8.043; 95% CI: 2.472 - 26.173, P = 0.001).
Our data suggest that children who undergo procedural sedation outside the operating room conducted by pediatric intensivists are safe and effectively treated. Receiving more than three sedative medications is the independent risk factor associated with serious adverse events.
手术室以外的儿科程序性镇静与镇痛（PSA）量一直在增加。这种高临床需求导致非麻醉医生，尤其是儿科重症监护医生、儿科医生和急诊医生，在进行程序性镇静中发挥作用。自2015年以来，我们科室已由儿科重症监护医生建立了PSA服务。
我们旨在评估儿科重症监护医生在手术室以外进行PSA的疗效和安全性，并确定严重不良事件的危险因素。
这是一项于2015年1月至2019年7月进行的回顾性描述性研究。纳入接受程序性镇静的20岁以下儿童。我们收集了人口统计学数据、镇静和镇痛药物、美国麻醉医师协会（ASA）身体状况分类、镇静指征、程序性镇静的成功率以及任何不良事件。
共纳入395例患者的561例程序性镇静病例。中位年龄为55个月（范围：15至119个月），58.5%（231/395）为男性。PSA下的手术成功率为99.3%。严重不良事件（SAE）发生率为2.7%。接受三种以上镇静药物的患者比接受较少药物的患者发生SAE的比例更高（根据年龄、镇静地点、手术类型和ASA分类进行调整）（优势比：8.043；95%置信区间：2.472 - 26.173，P = 0.001）。
我们的数据表明，由儿科重症监护医生在手术室以外进行程序性镇静的儿童得到了安全有效的治疗。接受三种以上镇静药物是与严重不良事件相关的独立危险因素。
