The effect of age on outpatient pediatric procedural sedation with intranasal dexmedetomidine and oral midazolam
The effect of age on outpatient pediatric procedural sedation with intranasal dexmedetomidine and oral midazolam
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DOI：
10.1007/s00431-023-05240-5
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发表时间：
2023-10-19
影响因子：
3.6
通讯作者：
Jin，Yue
中科院分区：
文献类型：
--
作者：
Zhou，Xiaqing;Zhao，Jialian;Jin，Yue
诊断检查时使用程序镇静是儿童的常见做法。该研究旨在分析鼻内右美托咪定联合口服咪达唑仑在不同年龄组门诊儿科程序镇静中的镇静效果和安全性，并评估镇静失败的发生率。回顾性纳入2021年2月至2021年9月接受程序镇静的儿童。根据年龄将孩子们分为4组：婴儿组（0至1岁）、幼儿组（1至3岁）、学龄前组（3至6岁）和学龄组（6至12岁）。使用 2 mcg/kg 鼻内右美托咪定和 0.5 mg/kg 口服咪达唑仑进行镇静。记录抢救后镇静成功率、镇静成功率、镇静起效时间、镇静时间。还分析了不良事件的发生率和镇静失败的危险因素。总共确定了 4758 名患者。排除后，最终纳入 3149 名患者。 2 mcg/kg 鼻内右美托咪定与 0.5 mg/kg 口服咪达唑仑组合的总成功率为 99.7%，镇静成功率为 91.4%。四组的镇静成功率有所不同：婴儿组为 90.2%，幼儿组为 93.1%，学龄前组为 92.7%，学龄组为 78.4%。学龄组镇静成功率显着低于其他三组（P<0.001）。婴儿镇静起效时间较短（22分钟，IQR：18-28分钟，P<0.001），学龄组镇静起效时间较长（30分钟，IQR：25-35分钟，P<0.05）。此外，婴儿的镇静时间较长（110分钟，IQR：90-135分钟，P<0.001），延迟恢复率较高（27.5%，均P<0.001）。不良事件发生率较低（4.70%），其中心动过缓（2.03%）最常见。年龄（0-1岁和 > 6岁）、体重、ASA II级和镇静失败史被确定为镇静失败的危险因素。结论：鼻内给予2-mcg/kg右美托咪定联合口服0.5-mg/kg咪达唑仑对于小儿手术镇静是有效且安全的。不同年龄组的儿童表现出不同的镇静特征，年龄被认为是影响镇静效果的危险因素。已知：•用于诊断检查的程序镇静是儿童的常见做法。•右美托咪定与咪达唑仑联合使用可以提高镇静效果。最新动态：•使用 2 mcg/kg 鼻内右美托咪定和咪达唑仑联合使用的镇静成功率与婴儿、幼儿和学龄前儿童相比，学龄儿童口服0.5 mg/kg咪达唑仑的剂量显着较低。•镇静起效时间随着年龄的增长而增加，婴儿患者的镇静时间更长。
Procedural sedation for diagnostic examination is a common practice in children. The study aims to analyze the sedative effect and safety of intranasal dexmedetomidine combined with oral midazolam in outpatient pediatric procedural sedation across different age groups and to assess the incidence of sedation failure. From February 2021 to September 2021, children who underwent procedural sedation were retrospectively enrolled. The children were divided into 4 groups based on age: the infant group (0 to 1 year old), toddler group (1 to 3 years old), preschool group (3 to 6 years old), and school-age group (6 to 12 years old). Two-mcg/kg intranasal dexmedetomidine and 0.5-mg/kg oral midazolam were used for sedation. The sedation success rate after rescue, sedation success rate, onset time of sedation, and the sedation time were recorded. The incidence of adverse events and the risk factors for sedation failure were also analyzed. A total of 4758 patients were identified. After exclusion, 3149 patients were ultimately enrolled. The combination of 2-mcg/kg intranasal dexmedetomidine and 0.5-mg/kg oral midazolam resulted in a total success rate of 99.7% and a sedation success rate of 91.4%. The sedation success rate varied among the four groups: 90.2% in the infant group, 93.1% in the toddler group, 92.7% in the preschool group, and 78.4% in the school-age group. The sedation success rate was significantly lower in the school-age group compared to the other three groups (P< 0.001). The onset time of sedation was shorter in infant (22 min, IQR: 18–28 min,P< 0.001) and longer in the school-age group (30 min, IQR: 25–35 min,P< 0.05). Additionally, the infants had a longer sedation time (110 min, IQR: 90–135 min,P< 0.001) and a higher rate of delayed recovery (27.5%, allP< 0.001). The incidence of adverse events was low (4.70%), which bradycardia (2.03%) being the most common. Age (0–1 year and > 6 years), weight, ASA class II, and history of failed sedation were identified as risk factors of sedation failure.Conclusion: Intranasal administration of 2-mcg/kg dexmedetomidine combined with oral administration of 0.5-mg/kg midazolam was found to be efficient and safety for pediatric procedural sedation. Different age groups of children exhibited distinct sedation characteristics, and age was identified as a risk factor affecting the efficacy of sedation.What is Known:•Procedural sedation for diagnostic examination is a common practice in children.•The combination of dexmedetomidine with midazolam can improve sedative effects.What is New:•The success rate of sedation using a combination of 2-mcg/kg intranasal dexmedetomidine and 0.5-mg/kg oral midazolam was significantly lower in school-age children as compared to infants, toddlers, and preschoolers.•The onset time of sedation increased with age, and the sedation time was found to be longer in infant patients.