Midazolam for conscious sedation during pediatric oncology procedures: safety and recovery parameters.
Midazolam for conscious sedation during pediatric oncology procedures: safety and recovery parameters.
复制标题
咪达唑仑在儿科肿瘤手术期间用于清醒镇静：安全性和恢复参数。
作者：
T. D. Sievers;J. D. Yee;M. Foley;P. Blanding;C. Berde
多次骨髓穿刺或活检和腰椎穿刺是许多儿科癌症患者诊断和治疗的必要组成部分。药物镇静可能会减少与这些程序相关的痛苦。咪达唑仑（MDZ，Versed）是一种水溶性、起效快、持续时间短的苯二氮卓类药物，尚未在儿童中进行广泛研究。我们前瞻性地评价了24例年龄在1.5至15.5岁之间的非卧床儿科癌症患者在70例手术（骨髓穿刺、腰椎穿刺或骨髓穿刺加腰椎穿刺）中由肿瘤学家（无麻醉师参与）用于静脉注射MDZ进行清醒镇静的安全性和恢复参数。MDZ单独使用或与吗啡或芬太尼联合使用。监测呼吸频率、血氧饱和度、血压和心率。采用行为评分和改良的恢复室出院评分评估镇静、抗焦虑和恢复情况。45%的手术不需要约束。在任何情况下，均未观察到呼吸频率低于12。在9例手术（13%）中，氧饱和度小于或等于90，均在MDZ末次给药后10分钟内发生。10例手术（14%）需要言语刺激来进行深呼吸。两名患者对言语刺激没有立即反应，并接受面罩吸氧。低氧血症与阿片类药物使用无关。低氧血症似乎与MDZ总剂量相关，可能发生在呼吸频率正常的情况下;所有病例均通过口头刺激或面罩吸氧解决，无需特定的气道操作或辅助通气。在所有70例手术中，心率和血压保持稳定。（250字处删节）
Multiple bone marrow aspirations or biopsies and lumbar punctures are a necessary part of the diagnosis and treatment of many pediatric cancer patients. Pharmacologic sedation may decrease the distress associated with these procedures. Midazolam (MDZ, Versed) is a water-soluble, rapid-onset, short-duration benzodiazepine that has not been studied widely in children. We prospectively evaluated safety and recovery parameters for intravenous MDZ used for conscious sedation by oncologists (without an anesthesiologist in attendance) for 70 procedures (bone marrow aspirations, lumbar punctures, or bone marrow aspirations plus lumbar punctures) in 24 ambulatory pediatric cancer patients, aged 1.5 to 15.5 years. MDZ was used alone or in combination with morphine or fentanyl. Respiratory rate, oxygen saturation, blood pressure, and heart rate were monitored. Sedation, anxiolysis, and recovery were assessed with a behavior score and a modified recovery room discharge score. Restraint was not required in 45% of the procedures. In no case was a respiratory rate less than 12 observed. In nine procedures (13%), an oxygen saturation less than or equal to 90 occurred, all within 10 minutes after the last dose of MDZ. Ten procedures (14%) required verbal stimulation to take deeper breaths. Two patients did not respond immediately to verbal stimulation and received face-mask oxygen. Hypoxemia was not correlated with opioid use. Hypoxemia appears to be related to total MDZ dose and may occur with normal respiratory rates; all cases resolved with verbal stimulation or face-mask oxygen without specific airway maneuvers or assisted ventilation. Heart rate and blood pressure remained stable in all 70 procedures.(ABSTRACT TRUNCATED AT 250 WORDS)