右美托咪定与丙泊酚-氯胺酮镇静在儿童磁共振成像中对肺不张的影响：一项随机临床试验。

Pulmonary Atelectasis After Sedation With Propofol vs Propofol-Ketamine for Magnetic Resonance Imaging in Children: A Randomized Clinical Trial.

机构信息

Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

JAMA Netw Open. 2024 Nov 4;7(11):e2433029. doi: 10.1001/jamanetworkopen.2024.33029.

DOI:10.1001/jamanetworkopen.2024.33029

PMID:39485355

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11530935/

Abstract

IMPORTANCE

Little is known about the impact of different anesthetic agents used for routine magnetic resonance imaging (MRI) sedation on pulmonary function in children.

OBJECTIVE

To compare the incidence of pulmonary atelectasis after MRI sedation with propofol vs propofol-ketamine.

DESIGN, SETTING, AND PARTICIPANTS: This double-masked randomized clinical trial screened 117 consecutive pediatric patients aged 3 to 12 years with American Society of Anesthesiologists physical status I to II undergoing elective MRI under deep sedation from November 2, 2022, to April 28, 2023, at a tertiary referral center. Four patients met the exclusion criteria, and 5 patients refused to participate. The participants and outcome assessors were masked to the group allocation.

INTERVENTIONS

During the MRI, the propofol group received 0.2 mL/kg of 1% propofol and 2 mL of 0.9% saline followed by a continuous infusion of propofol (200 μg/kg/min) and 0.9% saline (0.04 mL/kg/min). The propofol-ketamine group received 0.2 mL/kg of 0.5% propofol and 1 mg/kg of ketamine followed by a continuous infusion of propofol (100 μg/kg/min) and ketamine (20 μg/kg/min).

MAIN OUTCOME AND MEASURE

The incidence of atelectasis assessed by lung ultrasonography examination.

RESULTS

A total of 107 children (median [IQR] age, 5 [4-6] years; 62 male [57.9%]), with 54 in the propofol group and 53 in the propofol-ketamine group, were analyzed in this study. Notably, 48 (88.9%) and 31 (58.5%) patients had atelectasis in the propofol and propofol-ketamine groups, respectively (relative risk, 0.7; 95% CI, 0.5-0.8; P < .001). The incidence of desaturation and interruption of the MRI due to airway intervention or spontaneous movement did not significantly differ between the groups. The propofol-ketamine group showed a faster emergence time than the propofol group (15 [9-23] vs 25 [22-27] minutes in the propofol-ketamine vs propofol group; median difference in time, 9.0 minutes; 95% CI, 6.0-12.0 minutes; P < .001). No patient was withdrawn from the trial due to adverse effects.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, the propofol-ketamine combination reduced sedation-induced atelectasis while allowing for faster emergence compared with propofol alone.

TRIAL REGISTRATION

cris.nih.go.kr Identifier: KCT0007699.

摘要

重要性

关于在儿童中常规磁共振成像 (MRI) 镇静中使用不同麻醉剂对肺功能的影响知之甚少。

目的

比较丙泊酚与丙泊酚-氯胺酮镇静后 MRI 后肺不张的发生率。

设计、地点和参与者：这是一项双盲随机临床试验，筛选了 2022 年 11 月 2 日至 2023 年 4 月 28 日在一家三级转诊中心接受深度镇静下择期 MRI 的 117 名年龄在 3 至 12 岁的美国麻醉医师协会身体状况 I 至 II 级的连续儿科患者。有 4 名患者符合排除标准，有 5 名患者拒绝参加。参与者和结果评估者对分组分配不知情。

干预措施

在 MRI 期间，丙泊酚组接受 0.2 mL/kg 的 1%丙泊酚和 2 mL 的 0.9%生理盐水，然后连续输注丙泊酚（200 μg/kg/min）和 0.9%生理盐水（0.04 mL/kg/min）。丙泊酚-氯胺酮组接受 0.2 mL/kg 的 0.5%丙泊酚和 1 mg/kg 的氯胺酮，然后连续输注丙泊酚（100 μg/kg/min）和氯胺酮（20 μg/kg/min）。

主要结果和测量

肺超声检查评估的肺不张发生率。

结果

共有 107 名儿童（中位数 [IQR] 年龄，5 [4-6] 岁；62 名男性 [57.9%]），其中 54 名在丙泊酚组，53 名在丙泊酚-氯胺酮组，进行了这项研究。值得注意的是，丙泊酚组和丙泊酚-氯胺酮组分别有 48 名（88.9%）和 31 名（58.5%）患者出现肺不张（相对风险，0.7；95%CI，0.5-0.8；P < .001）。两组之间因气道干预或自发性运动导致的饱和度下降和 MRI 中断的发生率没有显著差异。丙泊酚-氯胺酮组的苏醒时间快于丙泊酚组（丙泊酚-氯胺酮组 15 [9-23] 与丙泊酚组 25 [22-27] 分钟；中位数差异时间，9.0 分钟；95%CI，6.0-12.0 分钟；P < .001）。没有患者因不良反应而退出试验。