General anaesthesia or conscious sedation for painful procedures in childhood cancer: the family‘s perspective
General anaesthesia or conscious sedation for painful procedures in childhood cancer: the family‘s perspective
复制标题
全身麻醉或清醒镇静治疗儿童癌症的痛苦手术：家人的观点
DOI：
10.1136/adc.88.3.253
复制
发表时间：
2003
影响因子：
5.2
通讯作者：
P. Monagle
中科院分区：
文献类型：
--
作者：
C. Crock;C. Olsson;R. Phillips;G. Chalkiadis;S. Sawyer;David M. Ashley;S. Camilleri;J. Carlin;P. Monagle
背景资料：直到最近，我们机构还经常使用咪达唑仑镇静剂对癌症儿童进行骨髓抽吸和腰椎穿刺。许多医生和护士认为，儿童及其家人对这种方法的耐受性很好。目的：比较吸入全麻和咪达唑仑镇静在这些手术中的效果。研究方法：共96例肿瘤性疾病儿童接受了七氟烷、一氧化二氮和氧气（GA）吸入全身麻醉或口服或鼻用咪达唑仑（SED）镇静，作为常规手术准备的一部分。这些孩子的经历在他们目前的程序和他们的第一次程序中进行了检查。主要结果指标是对儿童使用的身体约束程度，以及儿童在当前程序和首次程序期间经历的痛苦和疼痛程度。还确定了家属对未来程序的偏好。结果如下：在GA下的102个程序中，当首次应用麻醉面罩时，有4次（4%）需要约束，报告的疼痛最小，约25%的时间报告儿童感到痛苦。在80例SED手术中，94%的患者需要约束，66%的患者需要牢固约束，14%的患者无法约束，中位疼痛评分为6分（0分（无疼痛）至6分（最大疼痛）），90%的父母报告他们的孩子感到痛苦。90%的家庭希望GA用于未来的程序。许多家庭报告说，他们对镇静制度不满意，并对他们的孩子使用的约束提出了担忧。结论：这种全身麻醉方案最大限度地减少了对束缚的需要，并且与低水平的疼痛和痛苦相关。相比之下，镇静剂的效果要差得多。在儿童如何应对痛苦的程序方面，保健专业人员和家庭的看法存在很大差异。
Background: Until recently, midazolam sedation was routinely used in our institution for bone marrow aspirates and lumbar punctures in children with cancer. It has been perceived by many doctors and nurses as being well tolerated by children and their families. Aim: To compare the efficacy of inhalational general anaesthesia and midazolam sedation for these procedures. Methods: A total of 96 children with neoplastic disorders, who received either inhalational general anaesthesia with sevoflurane, nitrous oxide, and oxygen (GA) or sedation with oral or nasal midazolam (SED) as part of their routine preparation for procedures were studied. The experiences of these childen were examined during their current procedure and during their first ever procedure. Main outcome measures were the degree of physical restraint used on the child, and the levels of distress and pain experienced by the child during the current procedure and during the first procedure. The family‘s preference for future procedures was also determined. Results: During 102 procedures under GA, restraint was needed on four occasions (4%) when the anaesthetic mask was first applied, minimal pain was reported, and children were reported as distressed about 25% of the time. During 80 SED procedures, restraint was required in 94%, firm restraint was required in 66%, the child could not be restrained in 14%, median pain score was 6 (scale 0 (no pain) to 6 (maximum pain)), and 90% of the parents reported distress in their child. Ninety per cent of families wanted GA for future procedures. Many families reported dissatisfaction with the sedation regime and raised concerns about the restraint used on their child. Conclusions: This general anaesthetic regime minimised the need for restraint and was associated with low levels of pain and distress. The sedation regime, by contrast, was much less effective. There was a significant disparity between the perceptions of health professionals and those of families with respect to how children coped with painful procedures.