Wells Jenna B, Murman David H, Sullivan Alison L
Department of Surgery, Division of Emergency Medicine, University of Vermont College of Medicine, Burlington, VT, USA.
J Res Pharm Pract. 2021 Dec 25;10(3):144-148. doi: 10.4103/jrpp.jrpp_78_21. eCollection 2021 Jul-Sep.
Nasogastric tube (NGT) insertion is one of the most painful procedures in the emergency department (ED). A recent study determined that giving intravenous (IV) midazolam before NGT insertion decreased patients' pain; however, the sample size was insufficient to draw the conclusions on safety. We conducted a retrospective chart review of patients who received IV midazolam for NGT insertion to determine the frequency of adverse events.
All patients treated at a Level 1 trauma center ED from June 2016 to June 2019 who received IV midazolam for NGT insertion were included. The medical records were screened for the following serious adverse events: hypoxia, respiratory suppression, excessive somnolence/sedation, hemodynamic instability, epistaxis, vomiting, and choking. Adverse events, patient demographics, chief complaint, diagnosis, disposition, number of midazolam administrations, dose per administration, and total dose were recorded for the analysis.
Three out of 159 participants (2%) were identified as having an adverse event. In two cases, the adverse event was hypoxia, which was corrected with the administration of supplemental oxygen through nasal cannula. The third adverse event was somnolence noted in a patient who was also hypotensive and in atrial fibrillation around the time of midazolam administration.
It is safe to premedicate patients with midazolam before NGT insertions. Patients with borderline oxygen saturation and those receiving opioid analgesics may warrant dose titration with close vital sign monitoring.
在急诊科，插入鼻胃管（NGT）是最痛苦的操作之一。最近一项研究表明，在插入NGT前静脉注射咪达唑仑可减轻患者疼痛；然而，样本量不足以得出关于安全性的结论。我们对接受静脉注射咪达唑仑以插入NGT的患者进行了回顾性病历审查，以确定不良事件的发生率。
纳入2016年6月至2019年6月在一级创伤中心急诊科接受静脉注射咪达唑仑以插入NGT的所有患者。筛查病历以查找以下严重不良事件：低氧血症、呼吸抑制、过度嗜睡/镇静、血流动力学不稳定、鼻出血、呕吐和窒息。记录不良事件、患者人口统计学资料、主要症状、诊断、处置、咪达唑仑给药次数、每次给药剂量和总剂量，用于分析。
159名参与者中有3名（2%）被确定发生了不良事件。其中2例不良事件为低氧血症，通过鼻导管给予补充氧气后得到纠正。第三例不良事件是一名患者在给予咪达唑仑时出现嗜睡，同时伴有低血压和房颤。
在插入NGT前给患者使用咪达唑仑进行预处理是安全的。氧饱和度临界的患者以及接受阿片类镇痛药的患者可能需要在密切监测生命体征的情况下进行剂量滴定。
