Squires R H, Morriss F, Schluterman S, Drews B, Galyen L, Brown K O
Division of Gastroenterology and Nutrition, University of Texas Southwestern Medical Center at Dallas 75235-9063, USA.
Gastrointest Endosc. 1995 Feb;41(2):99-104. doi: 10.1016/s0016-5107(05)80589-9.
We prospectively evaluated 226 patients under 18 years of age who underwent 296 procedures, and intravenous sedation and general anesthesia were compared in regard to efficacy, safety, and cost. Children 6 to 9 years of age required the highest doses of midazolam (0.14 +/- 0.04 mg/kg) and meperidine (2.5 +/- 0.8 mg/kg). A Relative Adequacy Scale, constructed to assess each patient's arousal and cooperation during intravenous sedation, revealed a 95% completion rate. Heart rate monitored before, during, and after the procedure was similar in both groups during the procedure, but a lower preprocedure heart rate was noted in older patients having intravenous sedation, suggesting less patient anxiety. Average charges, excluding endoscopist's and pathology fees, were $768.52 in the intravenous sedation group versus $1,965.42 in the general anesthesia group. Endoscopic procedures can be performed safely, effectively, and at a lower cost to the patient under intravenous sedation in a properly equipped and staffed pediatric endoscopy suite.
我们前瞻性地评估了226例18岁以下接受296项手术的患者，并比较了静脉镇静和全身麻醉在疗效、安全性和成本方面的差异。6至9岁的儿童需要最高剂量的咪达唑仑（0.14±0.04毫克/千克）和哌替啶（2.5±0.8毫克/千克）。为评估静脉镇静期间每位患者的唤醒和合作情况而构建的相对充分性量表显示完成率为95%。两组患者在手术期间手术前、手术期间和手术后监测的心率相似，但接受静脉镇静的老年患者术前心率较低，表明患者焦虑程度较低。排除内镜医师和病理费用后，静脉镇静组的平均费用为768.52美元，全身麻醉组为1965.42美元。在设备齐全、人员配备充足的儿科内镜检查室，在静脉镇静下可以安全、有效地为患者进行内镜手术，且成本更低。
