Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China.
Pediatr Res. 2023 Dec;94(6):2054-2061. doi: 10.1038/s41390-023-02758-0. Epub 2023 Jul 28.
To assess the sedative failure rate over different dose combinations of intranasal dexmedetomidine and oral midazolam for procedural sedation.
This was a retrospective study. Four groups were established according to the initial dose of sedatives. The primary outcome was the sedative failure rate for different doses of the two-drug combination. The risk factors associated with sedation failure were analyzed.
A total of 2165 patients were included in the final analysis. Of these, 394 children were classified as sedation failure after the initial dose of a combination of intranasal dexmedetomidine and oral midazolam. Although the initial doses of intranasal dexmedetomidine and oral midazolam administered to patients varied widely, no significant differences were detected in the sedation outcomes among the groups. Multivariate analysis showed that sedation history, a history of sedation failure, and echocardiography were independent risk factors for sedation failure after an initial dose of intranasal dexmedetomidine and oral midazolam. In contrast, patients undergoing lung function and MRI were more likely to be successfully sedated.
A combination of low-dose intranasal dexmedetomidine and oral midazolam provides adequate sedation efficacy without any increase in side effects, especially for patients undergoing MRI or lung function examination.
This is an original article about the risk factors of sedation failure with an initial dose of intranasal dexmedetomidine and oral midazolam for procedure sedation. For patients undergoing echocardiogram, it is better to choose other sedatives, while a combination of intranasal dexmedetomidine and oral midazolam is a good option for patients undergoing MRI or lung function. The selection of sedative drugs should be personalized according to different procedures.
评估不同剂量组合的鼻腔内右美托咪定和口服咪达唑仑用于程序镇静的镇静失败率。
这是一项回顾性研究。根据镇静剂的初始剂量，建立了四个组。主要结局是两种药物组合不同剂量的镇静失败率。分析与镇静失败相关的危险因素。
共有 2165 名患者纳入最终分析。其中，394 名儿童在接受鼻腔内右美托咪定和口服咪达唑仑联合用药初始剂量后被归类为镇静失败。尽管患者接受的鼻腔内右美托咪定和口服咪达唑仑初始剂量差异很大，但各组的镇静结果无显著差异。多变量分析显示，镇静史、镇静失败史和超声心动图是初始剂量鼻腔内右美托咪定和口服咪达唑仑后镇静失败的独立危险因素。相比之下，接受肺功能和 MRI 的患者更有可能成功镇静。
低剂量鼻腔内右美托咪定和口服咪达唑仑联合用药可提供足够的镇静效果，而不会增加副作用，特别是对于接受 MRI 或肺功能检查的患者。
这是一篇关于初始剂量鼻腔内右美托咪定和口服咪达唑仑用于程序镇静时镇静失败的危险因素的原创文章。对于接受超声心动图的患者，最好选择其他镇静剂，而对于接受 MRI 或肺功能检查的患者，鼻腔内右美托咪定和口服咪达唑仑联合用药是一个不错的选择。镇静药物的选择应根据不同的程序进行个性化。
