Two-agent analgesia versus acetaminophen in children having bilateral myringotomies and tubes surgery.
Two-agent analgesia versus acetaminophen in children having bilateral myringotomies and tubes surgery.
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在接受双侧鼓膜切开术和管状手术的儿童中，双药镇痛与对乙酰氨基酚的比较。
DOI：
10.1111/j.1460-9592.2010.03427.x
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Lynn,Anne
中科院分区：
文献类型：
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作者：
Rampersad,Sally;Jimenez,Nathalia;Bradford,Heidi;Seidel,Kristy;Lynn,Anne
目的：本研究的目的是确定是否可以通过在直肠对乙酰氨基酚中添加额外的、起效更快的非静脉镇痛药，芬太尼鼻内或肌内（im）酮乐酸来减少突发性躁动（EA）的发生率。目的：比较小儿双侧鼓膜切开术（BM&T）后双药镇痛与单药对乙酰氨基酚镇痛后EA的发生率。背景：BM&T的麻醉通常使用挥发性麻醉药作为单一药物，没有固定的静脉通路。最常用的麻醉剂是七氟醚；然而，据报道，EA患者高达67%。出现时的躁动对父母来说是痛苦的，会损害护理人员充分监测孩子的能力，如果情况严重，还会导致孩子伤害自己。方法/材料：采用标准化麻醉，用药前口服咪达唑仑和七氟醚诱导和维持麻醉。所有患者直肠给予对乙酰氨基酚40 mg·kg−1，组1单独给予对乙酰氨基酚，组2给予对乙酰氨基酚和鼻内芬太尼1 mcg·kg−1，组3给予对乙酰氨基酚和肌内酮咯酸1 mg·kg−1。用卡方检验比较单独使用对乙酰氨基酚组和联合使用两种镇痛药组之间EA的发生率。结果：两组患者的人口学及临床特征无明显差异。在麻醉恢复期间的任何时间点，三组之间EA的发生率无统计学差异，疼痛评分和副作用也无统计学差异。由于使用第二种镇痛药，没有明显的副作用被报道。结论：我们得出结论，在降低BM&T手术七氟醚吸入麻醉后EA的发生率方面，双药镇痛并不优于单独对乙酰氨基酚。与之前的研究相比，我们的EA总发病率较低，这可能降低了我们检测组间差异的能力。
Objectives:The objective of this study was to determine whether the incidence of emergence agitation (EA) can be reduced by adding an additional, faster onset, non‐IV analgesic, intranasal fentanyl or intramuscular (im) ketorolac to rectal acetaminophen.Aim:To compare the incidence of EA after analgesia with two agents vs acetaminophen alone in pediatric patients after bilateral myringotomy procedures (BM&T).Background:Anesthesia for BM&T is usually performed with volatile anesthetics as a single agent without securing intravenous access. The anesthetic agent most commonly used is sevoflurane; however, EA has been reported in up to 67% of patients. Emergence agitation is distressing for parents, can impair the ability of nursing staff to adequately monitor the child, and can result in a child injuring him/herself if it is severe.Methods/Materials:A standardized anesthetic was used with oral midazolam premedication and sevoflurane for induction, and maintenance of anesthesia. All patients received 40 mg·kg−1rectal acetaminophen, group 1 received acetaminophen alone, group 2 received acetaminophen and 1 mcg·kg−1of intranasal fentanyl, and group 3 received acetaminophen and 1 mg·kg−1of intramuscular ketorolac. Incidence of EA was compared using chi‐square test between the acetaminophen group alone vs the two‐agent analgesia groups combined.Results:There were no differences in demographic and clinical characteristics between the two groups. There were no statistically significant differences between the three groups for the incidence of EA at any time point during recovery from anesthesia nor were there any significant differences in pain scores or side effects. No significant side effects because of the administration of a second analgesic agent were reported.Conclusions:We conclude that two‐agent analgesia is not superior to acetaminophen alone for decreasing the incidence of EA after inhalation anesthesia with sevoflurane for BM&T surgery. Our overall incidence of EA was low compared to previous studies, which could potentially have decreased our ability to detect differences between groups.