Roelofse J A, Louw L R, Roelofse P G
Faculty of Dentistry, University of Stellenbosch, Tygerberg, South Africa.
Anesth Prog. 1998 Winter;45(1):3-11.
The safety and efficacy of an oral sedation technique for children having minor oral surgical procedures under local anesthesia were studied. One hundred healthy children between the ages of 2 and 7 yr received either a combination of midazolam (0.35 mg/kg) and ketamine (5 mg/kg) (Group A), or a combination of trimeprazine (3 mg/kg) and methadone (0.2 mg/kg) (Group B) 30 min preoperatively. Hemodynamic parameters, adverse reactions, postoperative recovery, and behavior were evaluated. More children were asleep, but rousable to verbal commands, 30 min after drug administration in Group A (40%) than in Group B (8%). Immediately before the dental procedure, 46% of children in Group A were asleep in contrast to 8% of children in group B. Significantly more children in Group A were awake, coughing, crying, and moving purposefully 30 and 60 min after admission to the recovery room. Two children (4%) in Group A vomited. Ten (20%) children in Group A hallucinated compared to none in Group B. The surgeon rated the procedure as good or very good in 94% of children in Group A compared to 78% in Group B. Our results show that the combination of midazolam and ketamine, administered orally, is a safe, effective, and practical approach to managing children for minor oral surgical procedures under local anesthesia.
对局部麻醉下接受小型口腔外科手术的儿童采用口服镇静技术的安全性和有效性进行了研究。100名年龄在2至7岁的健康儿童在术前30分钟接受了咪达唑仑（0.35毫克/千克）和氯胺酮（5毫克/千克）的联合用药（A组），或异丙嗪（3毫克/千克）和美沙酮（0.2毫克/千克）的联合用药（B组）。对血流动力学参数、不良反应、术后恢复情况和行为进行了评估。用药30分钟后，A组入睡但能被言语指令唤醒的儿童（40%）比B组（8%）更多。在牙科手术即将开始前，A组46%的儿童入睡，而B组为8%。进入恢复室30分钟和60分钟后，A组明显有更多儿童清醒、咳嗽、哭泣并能自主活动。A组有2名儿童（4%）呕吐。A组有10名儿童（20%）出现幻觉，而B组无此情况。外科医生对A组94%的儿童手术评价为良好或非常好，而B组为78%。我们的结果表明，口服咪达唑仑和氯胺酮的联合用药是局部麻醉下管理儿童进行小型口腔外科手术的一种安全、有效且实用的方法。
