Safety of intravenous midazolam and fentanyl for pediatric GI endoscopy: prospective study of 1578 endoscopies
Safety of intravenous midazolam and fentanyl for pediatric GI endoscopy: prospective study of 1578 endoscopies
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DOI：
10.1016/j.gie.2006.05.002
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发表时间：
2007-02-01
影响因子：
7.7
通讯作者：
Liacouras, Chris A.
中科院分区：
文献类型：
--
作者：
Mamula, Petar;Markowitz, Jonathan E.;Liacouras, Chris A.
工作背景：静脉镇静在儿科GI endoscopy.Objective的安全性数据是稀疏的：静脉镇静GI endoscopy.Design/Settings的安全性进行评估：单中心前瞻性系列门诊GI endoscopies从2003年2月至2004年2月在费城儿童医院。记录的信息包括人口统计学，药物，和不良事件data.Patients：共1226 patients进行了studied.Main Outcome Measurements：与静脉镇静有关的不良事件的描述。在1578例手术中获得了镇静数据（92%，男/女674/552）：758例单独食管胃镜检查（EGD），116例单独结肠镜检查（COL），352例EGD和COL联合检查。芬太尼的中位剂量为2.77 μ g/kg（SD 0.97，范围0-6.73），咪达唑仑为0.11 mg/kg（SD 0.06，范围0-0.39）。平均恢复时间为118分钟（SD 47.3，范围31-375）。10例患者（0.8%）静脉镇静失败。在2例患者（0.2%）中观察到严重不良事件（呼吸暂停）。轻度或中度不良事件包括血氧饱和度下降低于92%持续不到20秒（100例患者，9%）、呕吐（64例患者，5%）、激越（15例患者，1%）、血氧饱和度下降低于92%持续超过20秒（12例患者，0.7%）和皮疹（8例患者，0.7%）。无需心肺复苏或镇静逆转。无患者需要住院治疗。结论：咪达唑仑和芬太尼静脉镇静用于小儿消化道内镜检查是安全的。严重不良事件罕见，无患者需要住院治疗。
Background: Data on safety of intravenous sedation in pediatric GI endoscopy are sparse.Objective: To evaluate safety of intravenous sedation for GI endoscopy.Design/Setting: Single-center prospective series of outpatient GI endoscopies performed from February 2003 to February 2004 at The Children's Hospital of Philadelphia. The recorded information included demographic, medication, and adverse event data.Patients: A total of 1226 patients were studied.Main Outcome Measurements: Description of adverse events relating to intravenous sedation.Results: A total of 2635 endoscopies were performed, of which 1717 were outpatient procedures with the patient under intravenous sedation. Sedation data were available on 1578 procedures (92%, M/F 674/552): 758 esophagogastroduodenoscopies (EGD) alone, 116 colonoscopies (COL) alone, and 352 combined EGD and COL. The median dose of fentanyl was 2.77 mu g/kg (SD 0.97, range 0-6.73), and of midazolam was 0.11 mg/kg (SD 0.06, range 0-0.39). The mean recovery time was 118 minutes (SD 47.3, range 31-375). Ten patients (0.8%) failed intravenous sedation. Serious adverse events (apnea) were noted in 2 patients (0.2%). Mild or moderate adverse events included desaturation below 92% for less than 20 seconds (100 patients, 9%), vomiting (64 patients, 5%), agitation (15 patients, 1%), desaturation below 92% for greater than 20 seconds (12 patients, 0.7%), and rash (8 patients, 0.7%). No cardiopulmonary resuscitation or sedation reversal was necessary. No patients required hospitalization. Patients younger than 6 years were more likely to develop respiratory adverse event (P < .01).Conclusions: Intravenous sedation with midazolam and fentanyl is safe for pediatric GI endoscopy. Serious adverse events are rare and no patient required hospitalization.