Emergency Medicine Department, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
BMC Emerg Med. 2024 Oct 9;24(1):182. doi: 10.1186/s12873-024-01097-5.
Children presenting to the emergency department (ED) often require procedural sedation and analgesia (PSA) prior to procedures. Although ketamine is used widely for PSA safely, there is a risk of adverse effects. Among them, vomiting is significant as it occurs in about 10% of patients and can potentially endanger the airway. Because there is evidence that post-operative complications might be due to anxiety prior to the operation, this study aims to investigate the association between pre-procedural anxiety and vomiting in the ED.
In this cohort study, a convenient sample of children aged 2 to 14 years who were a candidate for PSA with ketamine in the ED were enrolled. Anxiety was evaluated using the short version of the modified Yale preoperative anxiety scale (mYAS). Vomiting was recorded during the period of hospitalization in the ED and 24 h after discharge by a phone call. Association between anxiety level and vomiting was analyzed using the independent samples t-test and multivariable logistic regression was used to control for covariates.
102 children were enrolled and 93 were included in final analysis. The mean age of participants was 3.95 ± 1.79 years and 55.9% were male. According to the mYAS, the mean score of anxiety was 48.67 ± 21.78 in the waiting room and 59.10 ± 23.86 in the operating room. The mean score of anxiety was 58.3±25.3 and 51.0±20.7 in the vomiting and non-vomiting groups, respectively. At least one episode of vomiting was reported in 23 children of which, 19 took place in the hospital and 4 after discharge. No significant association was observed between pre-procedural anxiety and the occurrence of vomiting. On univariate regression model, the odds ratio of the association between mean anxiety and vomiting was 1.02 (CI 95%: 0.99-1.04) (P-value: 0.16). On the multivariable logistic regression model, after adjusting for all the covariates, the odds ratio was 1.03 (CI 95%: 1.0-1.05) (P-value: 0.05).
The present study showed that anxiety before procedural sedation and analgesia with ketamine in children was not associated with the incidence of vomiting.
儿童在急诊科（ED）就诊时，通常需要在进行操作前进行程序性镇静和镇痛（PSA）。虽然氯胺酮广泛用于安全 PSA，但存在不良反应的风险。其中，呕吐是一个显著的问题，约 10%的患者会出现呕吐，可能会危及气道。由于有证据表明手术前的焦虑可能与术后并发症有关，因此本研究旨在调查 ED 中术前焦虑与呕吐之间的关联。
在这项队列研究中，纳入了急诊科接受氯胺酮 PSA 的 2 至 14 岁儿童。使用改良耶鲁术前焦虑量表（mYAS）的短版评估焦虑程度。通过电话在 ED 住院期间和出院后 24 小时记录呕吐情况。使用独立样本 t 检验分析焦虑水平与呕吐之间的关系，并使用多变量逻辑回归控制协变量。
共纳入 102 例患儿，最终纳入 93 例进行分析。参与者的平均年龄为 3.95±1.79 岁，55.9%为男性。根据 mYAS，等候室的平均焦虑评分 48.67±21.78，手术室为 59.10±23.86。呕吐组和非呕吐组的平均焦虑评分分别为 58.3±25.3 和 51.0±20.7。23 例患儿至少出现过一次呕吐，其中 19 例发生在医院，4 例发生在出院后。术前焦虑与呕吐发生之间无显著相关性。在单变量回归模型中，焦虑均值与呕吐之间关联的优势比为 1.02（95%CI：0.99-1.04）（P 值：0.16）。在多变量逻辑回归模型中，调整所有协变量后，优势比为 1.03（95%CI：1.0-1.05）（P 值：0.05）。
本研究表明，接受氯胺酮 PSA 的儿童在镇静和镇痛前的焦虑与呕吐发生率无关。
