Ciavola Lorenzo, Sogni Francesco, Mucci Benedetta, Alfieri Eleonora, Tinella Angela, Mariotti Zani Elena, Esposito Susanna
Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy.
Pharmaceuticals (Basel). 2024 Nov 8;17(11):1506. doi: 10.3390/ph17111506.
Effective management of pain and anxiety in pediatric emergency room is crucial for ensuring both the physical and emotional well-being of young patients. Analgosedation, a combination of analgesia and sedation, is commonly used to facilitate various procedures in children. However, selecting the optimal agent and administration route remains challenging due to the unique pharmacological profiles and side effects of available drugs. This scoping review aims to provide a comprehensive analysis of the pharmacological agents used for procedural analgosedation in pediatric emergency settings, focusing on their efficacy, safety, administration routes, and potential side effects. A systematic review of the literature was conducted, focusing on key agents such as ketamine, midazolam, dexmedetomidine, fentanyl, and nitrous oxide. Studies were included based on their relevance to pediatric procedural sedation, particularly in emergency settings. Literature analysis showed that ketamine and fentanyl are effective for managing moderate to severe pain, with a rapid onset of action. Fentanyl is preferred for acute pain management following fractures and burns, while ketamine and midazolam are commonly used for emergency analgosedation. Dexmedetomidine, which induces sedation similar to natural sleep, is particularly effective in preventing pain and agitation during procedures and is well tolerated in children, especially those with developmental disorders. Nitrous oxide, when used in a 50% oxygen mixture, offers a valuable option for conscious sedation during mildly to moderately painful procedures, maintaining respiratory and airway reflexes. No single drug is ideal for all pediatric patients and procedures and the choice of agent should be tailored to the specific clinical scenario, considering both the sensory and affective components of pain. Future research should prioritize large-scale comparative studies, the exploration of combination therapies, and the development of non-pharmacological adjuncts to enhance the safety and efficacy of pediatric analgosedation.
在儿科急诊室有效管理疼痛和焦虑对于确保年轻患者的身心健康至关重要。镇痛镇静，即镇痛与镇静相结合，常用于辅助儿童进行各种操作。然而，由于现有药物独特的药理学特性和副作用，选择最佳药物及给药途径仍具有挑战性。本综述旨在全面分析用于儿科急诊环境中操作镇痛镇静的药物，重点关注其疗效、安全性、给药途径及潜在副作用。我们对文献进行了系统综述，重点关注氯胺酮、咪达唑仑、右美托咪定、芬太尼和一氧化二氮等关键药物。纳入的研究基于其与儿科操作镇静的相关性，尤其是在急诊环境中的相关性。文献分析表明，氯胺酮和芬太尼对中度至重度疼痛的管理有效，起效迅速。芬太尼更适用于骨折和烧伤后的急性疼痛管理，而氯胺酮和咪达唑仑常用于急诊镇痛镇静。右美托咪定诱导的镇静类似于自然睡眠，在预防操作过程中的疼痛和躁动方面特别有效，且儿童耐受性良好，尤其是那些患有发育障碍的儿童。一氧化二氮与50%的氧气混合使用时，为轻度至中度疼痛操作期间的清醒镇静提供了一个有价值的选择，可维持呼吸和气道反射。没有一种药物对所有儿科患者和操作都是理想的，药物的选择应根据具体临床情况进行调整，同时考虑疼痛的感觉和情感成分。未来的研究应优先进行大规模比较研究、探索联合疗法以及开发非药物辅助手段，以提高儿科镇痛镇静的安全性和有效性。
