Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario K1H 8L1, Canada.
Department of Pediatrics, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO 80045, USA.
Am J Emerg Med. 2021 Aug;46:116-120. doi: 10.1016/j.ajem.2021.03.014. Epub 2021 Mar 10.
Relatively little is known about outcomes of procedural sedation in very young children. Our objective was to examine the association between procedural sedation in young children (≤ 2 years) and the incidence of sedation-related adverse events.
This is a secondary analysis of a prospective cohort study of children 0 to 18 years undergoing parenteral procedural sedation in six Canadian pediatric emergency departments (ED). The primary risk factor was age ≤ 2 years. Secondary risk factors were sex, procedure type, pre-procedure and sedation medications. The outcomes examined were: serious adverse events (SAE), significant interventions, oxygen desaturation and vomiting.
Of the 6295 patients included, 946 (15%) were ≤2 years. Children 13-24 months comprised 90% of the young age group. Children ≤ 2 years were sedated most commonly for laceration repair (n = 450; 47.6%), while orthopedic reduction was most common in children > 2 (n = 3983; 74.5%). Ketamine was the most common medication in both groups, but was used more frequently in children ≤ 2 years (80.9% vs 58.9%; p < 0.001). There was no difference in the odds of SAE (OR 0.83, 95% Confidence Interval (CI) 0.4 to 1.9), significant intervention (OR 0.82, 95% CI 0.4 to 1.7) or oxygen desaturation (OR 0.95, 95% CI 0.7 to 1.3) between age groups, however children ≤ 2 years vomited less frequently (OR 0.24, 95% CI 0.1 to 0.6).
Young age, specifically between 13 and 24 months, was not associated with a significant difference in the incidence of adverse events.
关于非常年幼儿童的程序镇静的结果，人们知之甚少。我们的目的是检查幼儿（≤2 岁）进行程序镇静与镇静相关不良事件的发生率之间的关联。
这是对 6 家加拿大儿科急诊室（ED）进行的儿童 0 至 18 岁接受肠外程序镇静的前瞻性队列研究的二次分析。主要危险因素是年龄≤2 岁。次要危险因素为性别、手术类型、术前和镇静药物。检查的结果是：严重不良事件（SAE）、重大干预、氧饱和度下降和呕吐。
在纳入的 6295 名患者中，有 946 名（15%）≤2 岁。13-24 个月的儿童占年轻组的 90%。≤2 岁的儿童最常接受撕裂伤修复镇静（n=450；47.6%），而>2 岁的儿童最常接受骨科复位（n=3983；74.5%）。两组中最常用的药物均为氯胺酮，但在≤2 岁的儿童中更常用（80.9%比 58.9%；p<0.001）。两组之间 SAE（OR 0.83，95%置信区间（CI）0.4 至 1.9）、重大干预（OR 0.82，95% CI 0.4 至 1.7）或氧饱和度下降（OR 0.95，95% CI 0.7 至 1.3）的发生率均无差异，然而≤2 岁的儿童呕吐的频率较低（OR 0.24，95% CI 0.1 至 0.6）。
年龄较小，特别是 13 至 24 个月，与不良事件发生率无显著差异相关。
