Kessler P, Alemdag Y, Hill M, Dietz S, Vettermann J
Zentrum der Anästhesiologie und Wiederbelebung, Johann Wolfgang Goethe-Universität, Frankfurt am Main.
Anaesthesist. 1996 Dec;45(12):1158-66. doi: 10.1007/s001010050352.
The purpose of the present study was to compare two sedation regimens with either propofol (P) or methohexital (M) for elective magnetic resonance imaging (MRI) in children with respect to safety, side effects, recovery, and discharge time.
After Institutional Review Board approval, 120 unpremedicated children with a mean age of 26.5 +/- 21.4 months (M) and 28.1 +/- 19.9 months (P) were randomly assigned to receive a hypnotic induction dose of either M or P. Supplemental bolus injections of M or P were administered to maintain adequate sedation. The following parameters were measured: heart rate, oxygen saturation by pulse oximetry (SpO2), respiratory rate, end-tidal CO2 (PetCO2), side effects, and recovery and discharge times.
Spontaneous respiration was maintained in all patients, and ventilatory support was only necessary for 2 min in 1 M patient immediately after the induction dose. The mean loading and total doses for M were 2.3 +/- 0.7 and 6.1 +/- 3.3 mg/kg respectively, and for P 2.3 +/- 0.9 and 5.8 +/- 2.7 mg/kg. Following induction SpO2 < 90% occurred in 0.49% with M and in 0.64% with P (n.s.). Apnoe > 20s was observed in 2 children each after M and P (n.s.). The frequency of hypoventilation (PetCO2 > 48 mmHg) was 0.36% in the M group and 0.71% in the P group (n.s.). MRI sequences had to be repeated in 5% of the children in each group because of spontaneous movements. The heart rate fell significantly during MRI in both groups, while P children had lower frequencies than M children (P < 0.01). Recovery and discharge times were significantly shorter in the P group, at 0.8 min (0.08-4.8) and 2.2 min (0.2-15.0), compared to 1.5 min (0.3-28.5) and 3.5 min (0.6-40.0) in patients receiving P (P < 0.01). No patient required admission to the postanaesthesia care unit and all were free from nausea and vomiting.
Intravenous sedation with M or P using the reported technique is a safe regimen for children undergoing elective MRI. The fast recovery and discharge times seem to offer advantages over general anaesthesia with endotracheal intubation. The faster recovery and discharge of only a few minutes after P compared with M is without clinical relevance.
本研究的目的是比较丙泊酚（P）或美索比妥（M）两种镇静方案用于儿童择期磁共振成像（MRI）时在安全性、副作用、恢复情况及出院时间方面的差异。
经机构审查委员会批准，120例未用术前药的儿童，平均年龄（M组26.5±21.4个月，P组28.1±19.9个月）被随机分配接受M或P的催眠诱导剂量。给予M或P补充推注以维持足够的镇静。测量以下参数：心率、脉搏血氧饱和度（SpO₂）、呼吸频率、呼气末二氧化碳分压（PetCO₂）、副作用以及恢复和出院时间。
所有患者均维持自主呼吸，仅1例M组患者在诱导剂量后立即需要2分钟的通气支持。M组的平均负荷剂量和总剂量分别为2.3±0.7和6.1±3.3mg/kg，P组为2.3±0.9和5.8±2.7mg/kg。诱导后SpO₂<90%在M组发生率为0.49%，P组为0.64%（无统计学差异）。M组和P组各有2例儿童观察到呼吸暂停>20秒（无统计学差异）。低通气频率（PetCO₂>48mmHg）在M组为0.36%，P组为0.71%（无统计学差异）。每组5%的儿童因自主运动需重复MRI序列。两组在MRI期间心率均显著下降，而P组儿童下降频率低于M组儿童（P<0.01）。P组的恢复和出院时间显著更短，分别为0.8分钟（0.08 - 4.8）和2.2分钟（0.2 - 15.0），而接受M组分别为1.5分钟（0.3 - 28.5）和3.5分钟（0.6 - 40.0）（P<0.01）。无患者需要进入麻醉后护理单元，且所有患者均无恶心和呕吐。
采用报告的技术用M或P进行静脉镇静对接受择期MRI的儿童是一种安全的方案。与气管插管全身麻醉相比，快速恢复和出院时间似乎具有优势。与M相比，P组仅几分钟的更快恢复和出院在临床上并无相关性。
