D'Agostino J, Terndrup T E
Department of Emergency Medicine, State University of New York Health Science Center at Syracuse, USA.
Drug Saf. 1996 Mar;14(3):146-57. doi: 10.2165/00002018-199614030-00002.
Children often fear medical procedures and interventions. Sedative agents enhance the care of these children who undergo outpatient procedures by decreasing anxiety, increasing cooperativity, and providing amnesia. Although higher dosages and intravenous administration of sedatives often produce improved sedation, adverse effects and complications are more frequent. The goals of therapeutic efficacy and safety must be balanced in all patients. The presence or anticipation of anxiety and pain helps in deciding whether to use a sedative alone, or a regimen also providing analgesia. The patient's clinical cardiorespiratory or neurological status, other relative contraindications, the duration of the intended procedure, and the presence or absence of an intravenous line will help in choosing specific drugs. Drug complications are a common cause of adverse events in patients. The combination of a sedative and analgesic, especially a benzodiazepine and an opioid given intravenously, is associated with a higher risk of serious complications. The practitioner responsible for the administration of a sedative to a child must be competent in its use and have the ability to detect and manage complications. Patients who are deeply sedated should be continuously monitored and observed by an individual dedicated to this task. Vital signs and oxygen saturation should be documented at frequent intervals and the patient should be appropriately monitored until discharge criteria have been met. The risk of serious complications with these agents may be reduced with vigorous monitoring and a judicious choice of dosage.
儿童常常害怕医疗程序和干预措施。镇静剂通过减轻焦虑、增强合作性并产生遗忘作用，改善了接受门诊手术的儿童的护理情况。尽管较高剂量和静脉注射镇静剂通常能产生更好的镇静效果，但不良反应和并发症更为常见。在所有患者中，必须平衡治疗效果和安全性的目标。焦虑和疼痛的存在或预期有助于决定是单独使用镇静剂，还是采用同时提供镇痛作用的方案。患者的临床心肺或神经状态、其他相对禁忌证、预期手术的持续时间以及是否有静脉通路，将有助于选择特定的药物。药物并发症是患者不良事件的常见原因。镇静剂和镇痛药的联合使用，尤其是静脉注射苯二氮䓬类药物和阿片类药物，会增加严重并发症的风险。负责给儿童使用镇静剂的从业者必须熟练掌握其用法，并具备检测和处理并发症的能力。深度镇静的患者应由专人持续监测和观察。应定期记录生命体征和血氧饱和度，并且应对患者进行适当监测，直至达到出院标准。通过严格监测和谨慎选择剂量，可降低使用这些药物时严重并发症的风险。
