Li Hong-Pei, Liu Kun-Peng, Yao Lan
Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China.
Department of Anesthesiology, Peking University International Hospital, Beijing 102206, China.
Am J Emerg Med. 2021 Dec;50:442-448. doi: 10.1016/j.ajem.2021.08.073. Epub 2021 Aug 31.
To evaluate effectiveness of combinational use of dexmedetomidine and ketamine (DEX-KET) for pediatric procedural sedation or premedication.
Relevant studies were identified after a literature search in electronic databases and study selection was based on precise eligibility criteria. Meta-analyses of mean differences were performed to examine differences in sedation onset and recovery times between DEX-KET and comparators. Changes from baseline in heart rate (HR), respiratory rate, oxygen saturation, and mean arterial pressure (MAP), were pooled. Meta-analyses of proportions were performed to estimate incidence of adverse events.
15 studies (1087 patients) were included. Onset of sedation was significantly shorter in DEX-KET than in DEX group. HR declined in DEX-KET group from start (-3.5 beats per minute (BPM) [95% CI: -5.1, -1.9]) through midpoint (-7.2 BPM [95% CI: -12.1, -2.3]) and at end of sedation (-8.7 BPM [95% CI: -13.1, -4.4]). Decrease in HR after DEX administration at start was -11.6 BPM [95% CI: -16.0, -7.1] and remained consistent afterward. There was no change in MAP during DEX-KET sedation. However, after DEX administration, MAP decreased by -6.9 [95% CI: -10.4, -3.3] at start, -7.8 [95% CI: -11.4, -4.2] at middle, and by -6.6 [95% CI: -14.4, 1.1] at end of sedation. Incidence of hypotension was 3% [95% CI: 0, 9] in DEX-KET, 7% [95% CI: 2, 14] in DEX, and 0% [95% CI: 0, 2] in KET groups. Incidence of bradycardia was 2% [95% CI: 0, 6] with DEX-KET and 12% [95% CI: 5, 20] with DEX. Incidence of oxygen desaturation was 3% [95% CI: 0, 8] in DEX-KET, 2% [95% CI: 0, 6] in DEX, 12% [95% CI: 5, 20] in KET, and 13% [95% CI: 6, 21] in PROP-KET groups. MIDA-KET sedation had 13% [95% CI: 4, 25] incidence of tachycardia.
DEX-KET for pediatric sedation results in better sedation outcomes than DEX or KET by shortening onset of sedation and recovery while maintaining hemodynamic and respiratory stability with low incidence of adverse events. DEX sedation was associated with higher incidence of bradycardia. Higher incidence of oxygen desaturation was observed with KET and PROP-KET whereas MIDA-KET was associated with higher incidence of tachycardia.
评估右美托咪定与氯胺酮联合使用（DEX-KET）用于儿科操作镇静或术前用药的有效性。
通过在电子数据库中进行文献检索来确定相关研究，并根据精确的纳入标准进行研究选择。进行均值差异的荟萃分析，以检验DEX-KET与对照药物在镇静起效时间和恢复时间上的差异。汇总心率（HR）、呼吸频率、血氧饱和度和平均动脉压（MAP）相对于基线的变化。进行比例的荟萃分析以估计不良事件的发生率。
纳入15项研究（1087例患者）。DEX-KET的镇静起效时间显著短于DEX组。DEX-KET组的HR从开始时下降（-3.5次/分钟（BPM）[95%CI：-5.1，-1.9]）到中点时（-7.2 BPM [95%CI：-12.1，-2.3]）以及镇静结束时（-8.7 BPM [95%CI：-13.1，-4.4]）。DEX给药开始时HR下降-11.6 BPM [95%CI：-16.0，-7.1]，之后保持一致。DEX-KET镇静期间MAP无变化。然而，DEX给药后，开始时MAP下降-6.9 [95%CI：-10.4，-3.3]，中点时下降-7.8 [95%CI：-11.4，-4.2]，镇静结束时下降-6.6 [95%CI：-14.4，1.1]。DEX-KET组低血压发生率为3% [95%CI：0，9]，DEX组为7% [95%CI：2，14]，KET组为0% [95%CI：0，2]。DEX-KET组心动过缓发生率为2% [95%CI：0，6]，DEX组为12% [95%CI：5，20]。DEX-KET组血氧饱和度降低发生率为3% [95%CI：0，8]，DEX组为2% [95%CI：0，6]，KET组为12% [95%CI：5，20]，PROP-KET组为13% [95%CI：6，21]。MIDA-KET镇静心动过速发生率为13% [95%CI：4，25]。
DEX-KET用于儿科镇静通过缩短镇静起效时间和恢复时间，同时维持血流动力学和呼吸稳定性且不良事件发生率低，比DEX或KET产生更好的镇静效果。DEX镇静与较高的心动过缓发生率相关。KET和PROP-KET观察到较高的血氧饱和度降低发生率，而MIDA-KET与较高的心动过速发生率相关。
