Alfonzo-Echeverri E C, Berg J H, Wild T W, Glass N L
Department of Pediatric Dentistry, University of Texas Health Science Center, Houston, Texas.
Pediatr Dent. 1993 May-Jun;15(3):182-5.
This study compared the sedative effectiveness of orally administered ketamine to a combination of oral meperidine/promethazine (Demerol/Phenergan) in two groups of children. One group received ketamine at a dose of 6 mg/kg and the other group received meperidine/promethazine combination at a dose of 2 mg/kg and 0.5 mg/kg, respectively. All children received nitrous oxide 30-50% titrated to effect. A four-point modification of the Houpt et al. rating scale for the overall behavior was used in the evaluations. The quality of sedation, as rated by subjective measurement of overall behavior (sleep, crying, body movement), was higher in the ketamine group (borderline significance; P = 0.07). Mean onset time was significantly shorter (P < 0.001) for ketamine (20.5 min) than meperidine/promethazine (42.4 min) and postoperative sleep time (recovery) was also shorter (borderline significance; P = 0.08) for ketamine (55.6 min) than meperidine/promethazine (106.8 min). Operative times were similar, but the placement of rubber dam and local anesthetic were slightly better tolerated in the ketamine group. Vomiting was significantly more prevalent (P = 0.05) among those who received oral ketamine. Vital signs were consistent for the two groups with no oxygen desaturation below 95%.
本研究比较了口服氯胺酮与口服哌替啶/异丙嗪（度冷丁/非那根）组合对两组儿童的镇静效果。一组儿童接受6mg/kg剂量的氯胺酮，另一组儿童分别接受2mg/kg和0.5mg/kg剂量的哌替啶/异丙嗪组合。所有儿童均吸入30%-50%的氧化亚氮，根据效果进行滴定。评估采用了对Houpt等人整体行为评分量表的四点修改版。通过对整体行为（睡眠、哭闹、身体活动）的主观测量来评定的镇静质量，氯胺酮组更高（临界显著性；P = 0.07）。氯胺酮的平均起效时间（20.5分钟）明显短于哌替啶/异丙嗪（42.4分钟）（P < 0.001），氯胺酮的术后睡眠时间（恢复时间）（55.6分钟）也短于哌替啶/异丙嗪（106.8分钟）（临界显著性；P = 0.08）。手术时间相似，但氯胺酮组对橡皮障和局部麻醉剂的耐受性略好。口服氯胺酮的儿童中呕吐明显更普遍（P = 0.05）。两组的生命体征一致，均未出现低于95%的氧饱和度下降。
