雾化氯胺酮与不同药理学方法在儿科镇静中的效果比较：随机对照试验的系统评价和荟萃分析。
Comparison of the effects of ketamine via nebulization versus different pharmacological approaches in pediatric sedation: a systematic review and meta-analysis of randomized controlled trials.
机构信息
Department of Pharmacy, The Third People's Hospital of Chengdu, The Affiliated Hospital of Southwest Jiaotong University, Chengdu, China.
Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China.
出版信息
BMC Anesthesiol. 2023 Nov 16;23(1):375. doi: 10.1186/s12871-023-02298-4.
BACKGROUND
Nebulized drug delivery is commonly used in pediatric clinical practice. The growing number of literatures have reported the application of nebulized ketamine in pediatric sedation in recent years. This meta-analysis of randomized controlled trials comparing the efficacy and safety of nebulized ketamine versus different pharmacological approaches was conducted to estimate the effects of this technique in pediatric sedation.
METHODS
We searched PubMed, Embase, and Cochrane Library from inception to Feb 2023. All randomized controlled trials used nebulized ketamine as presurgical and pre-procedural sedatives in children were included. Sedative effects and various adverse events were considered as the outcomes.
RESULTS
Ten studies with 727 pediatric patients were enrolled. Compared to nebulized dexmedetomidine, using of ketamine via nebulization showed similar sedation satisfaction (54.79% vs. 60.69%, RR = 0.88, with 95%CI [0.61, 1.27]), success rate of parental separation (57.27% vs. 73.64%, RR = 0.81, with 95%CI [0.61, 1.08]), and mask acceptability (37.27% vs. 52.73%, RR = 0.71, with 95%CI [0.45, 1.10]). However, the using of combination of two medications (nebulized ketamine plus nebulized dexmedetomidine) was associated with better sedative satisfaction (33.82% vs. 68.11%, RR = 0.50, with 95%CI [0.27, 0.92]) and more satisfactory mask acceptance (45.59% vs. 71.01%, RR = 0.69, with 95%CI [0.56, 0.86]). Compared with nebulized ketamine, using of nebulized dexmedetomidine was associated with less incidence of emergence agitation (18.18% vs. 3.33%, RR = 4.98, with 95%CI [1.88, 13.16]).
CONCLUSIONS
Based on current evidences, compared to nebulized dexmedetomidine, nebulized ketamine provides inconspicuous advantages in pediatric sedation, and it has a relatively high incidence of emergence agitation. Combination of nebulized ketamine and dexmedetomidine might be considered as one preferred option in pediatric sedation as it can provide more satisfactory sedative effects. However, there is insufficient evidence regarding nebulized ketamine versus ketamine administered through other routes and nebulized ketamine versus other sedatives. The overall low or moderate quality of evidence evaluated by the GRADE system also calls for more high-quality studies with larger sample sizes in future.
RESEARCH REGISTRATION
The protocol of present study was registered with PROSPERO (CRD42023403226).
背景
雾化给药在儿科临床实践中被广泛应用。近年来，越来越多的文献报道了雾化氯胺酮在儿科镇静中的应用。本荟萃分析纳入了比较雾化氯胺酮与不同药理学方法疗效和安全性的随机对照试验，旨在评估该技术在儿科镇静中的作用。
方法
我们检索了 PubMed、Embase 和 Cochrane Library 从成立到 2023 年 2 月的所有文献。所有使用雾化氯胺酮作为术前和术前镇静剂的儿科随机对照试验均被纳入。镇静效果和各种不良事件被视为结局。
结果
共纳入 10 项研究，727 例儿科患者。与雾化右美托咪定相比，使用雾化氯胺酮的镇静满意度相似（54.79% vs. 60.69%，RR=0.88，95%CI[0.61,1.27]），父母分离成功率（57.27% vs. 73.64%，RR=0.81，95%CI[0.61,1.08]）和面罩接受率（37.27% vs. 52.73%，RR=0.71，95%CI[0.45,1.10]）。然而，联合使用两种药物（雾化氯胺酮加雾化右美托咪定）可提高镇静满意度（33.82% vs. 68.11%，RR=0.50，95%CI[0.27,0.92]）和面罩接受率（45.59% vs. 71.01%，RR=0.69，95%CI[0.56,0.86]）。与雾化氯胺酮相比，使用雾化右美托咪定与较低的苏醒期躁动发生率相关（18.18% vs. 3.33%，RR=4.98，95%CI[1.88,13.16]）。
结论
基于目前的证据，与雾化右美托咪定相比，雾化氯胺酮在儿科镇静中并没有明显优势，而且它的苏醒期躁动发生率较高。雾化氯胺酮和右美托咪定联合应用可能是儿科镇静的一种首选方案，因为它可以提供更满意的镇静效果。然而，关于雾化氯胺酮与其他途径给予的氯胺酮以及雾化氯胺酮与其他镇静剂的比较，证据不足。由 GRADE 系统评估的整体低或中等质量证据也呼吁未来进行更多高质量、大样本量的研究。
研究注册
本研究方案已在 PROSPERO（CRD42023403226）注册。
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