Department of Pharmacy, Department of Emergency Medicine, Valleywise Health Medical Center, Phoenix, Arizona.
J Emerg Med. 2022 Aug;63(2):290-295. doi: 10.1016/j.jemermed.2021.10.011. Epub 2022 Jun 9.
The use of sedative and analgesic agents is required for procedural sedation in the emergency department (ED). Agents such as ketamine and propofol are commonly used for procedural sedation. This is likely due to clinical experience with these agents, as well as optimal pharmacologic properties when used in combination with one another. Methohexital, a barbiturate, is less frequently used due to concerns for adverse events associated with this drug class.
The objective of this study is to evaluate the safety of methohexital in comparison with ketamine and propofol when used for procedural sedation in musculoskeletal procedures.
A retrospective chart review was conducted to evaluate adult ED patients who received ketamine, propofol, or methohexital for procedural sedation from January 1, 2014 to June 30, 2020.
Overall, a total of 43 procedures were included in the study. Procedures included shoulder relocation, elbow relocation, hip relocation, ankle reduction, radius/ulnar reduction, mandibular relocation, patellar relocation, and wrist reduction. There was a 90.6% overall procedural success rate, which was similar between groups. Overall adverse events occurred in 34.8% of patients. Respiratory depression occurred in 9.3% of patients. No incidence of respiratory depression was observed in the methohexital group, compared with 2 patients receiving ketamine and 4 receiving propofol (p = 0.44).
Methohexital is a safe and effective option for procedural sedation for musculoskeletal procedures in the ED when compared with ketamine and propofol.
在急诊科（ED）进行程序镇静时需要使用镇静和镇痛药物。诸如氯胺酮和丙泊酚等药物通常用于程序镇静。这可能是由于临床使用这些药物的经验，以及当与其他药物联合使用时具有最佳的药理特性。由于担心与该药物类别相关的不良事件，巴比妥类药物甲己炔巴比妥的使用频率较低。
本研究的目的是评估在肌肉骨骼程序中使用甲己炔巴比妥进行程序镇静与氯胺酮和丙泊酚相比的安全性。
进行了回顾性图表审查，以评估 2014 年 1 月 1 日至 2020 年 6 月 30 日期间接受氯胺酮、丙泊酚或甲己炔巴比妥进行程序镇静的成年 ED 患者。
总体而言，该研究共纳入了 43 例程序。包括肩部复位、肘部复位、臀部复位、踝关节复位、桡骨/尺骨复位、下颌复位、髌骨复位和腕关节复位。总体程序成功率为 90.6%，各组之间相似。总体不良事件发生率为 34.8%。呼吸抑制发生在 9.3%的患者中。在甲己炔巴比妥组未观察到呼吸抑制的发生率，而接受氯胺酮的患者中有 2 例，接受丙泊酚的患者中有 4 例（p=0.44）。
与氯胺酮和丙泊酚相比，甲己炔巴比妥是 ED 肌肉骨骼程序镇静的安全有效选择。
