Ilkhanipour K, Juels C R, Langdorf M I
Department of Medicine, University of California Irvine Medical Center, USA.
Acad Emerg Med. 1994 Jul-Aug;1(4):368-72. doi: 10.1111/j.1553-2712.1994.tb02647.x.
To determine the availability and relative use of pediatric analgesia and sedation at sites of U.S. emergency medicine residency training programs.
A mail/telephone survey of residency directors at 80 U.S. emergency medicine residencies regarding resident experience with pediatric analgesia and sedation for painful procedures conducted during November 1991.
Sixty of 80 surveys (75%) were completed and available for analysis. Emergency medicine faculty supervised conscious sedation and analgesia in 87% of responding programs, while pediatrics faculty and pediatrics-emergency medicine fellows supervised in the remainder. Ninety-three percent of the programs had sedating agents available in the emergency department; only four programs needed to have drugs brought from the pharmacy. Thirty-four programs (57%) had formal protocols for the administration of these drugs. Seventy-seven percent of the programs had airway resuscitation equipment at the bedside, while only 63% brought resuscitation drugs. However, 60% of the programs reported complications of sedation, including respiratory depression, prolonged sedation, agitation, and vomiting. The most commonly used agents were midazolam (82%), meperidine alone (68%) and with promethazine and chlorpromazine (67%), and chloral hydrate (67%). Only 25% of the programs used nitrous oxide, and 30% used ketamine.
Emergency medicine residencies generally have available agents for pain control and conscious sedation in children, although the agents used vary widely. Appropriate instruction by trained faculty should enhance resident experience with pediatric pain control and sedation.
确定美国急诊医学住院医师培训项目机构中患儿镇痛和镇静的可用性及相对使用情况。
对美国80个急诊医学住院医师培训项目的主任进行邮件/电话调查，了解1991年11月期间住院医师在实施疼痛性操作时对患儿进行镇痛和镇静的经验。
80份调查问卷中有60份（75%）完成并可供分析。在87%的回复项目中，急诊医学教员监督清醒镇静和镇痛，其余项目由儿科学教员及儿科-急诊医学研究员监督。93%的项目急诊科备有镇静剂；只有4个项目需要从药房拿药。34个项目（57%）有这些药物给药的正式方案。77%的项目床边备有气道复苏设备，而只有63%的项目备有复苏药物。然而，60%的项目报告了镇静相关并发症，包括呼吸抑制、镇静时间延长、躁动和呕吐。最常用的药物是咪达唑仑（82%）、单独使用哌替啶（68%）以及与异丙嗪和氯丙嗪联用（67%）、水合氯醛（67%）。只有25%的项目使用氧化亚氮，30%的项目使用氯胺酮。
急诊医学住院医师培训项目一般备有用于儿童疼痛控制和清醒镇静的药物，尽管使用的药物差异很大。经培训的教员进行适当指导应能提升住院医师在儿童疼痛控制和镇静方面的经验。
