Efficacy, safety and satisfaction of sedation-analgesia in Spanish emergency departments

被引：6

作者：

Miguez Navarro, Concepcion ^{[1
]}

Oikonomopoulou, Niki ^{[1
]}

Rivas Garcia, Aristides ^{[1
]}

Mora Capin, Andrea ^{[1
]}

Guerrero Marquez, Gloria ^{[1
]}

Fernandez Lorente, Ana Isabel ^{[2
]}

de Gracia Calvo, Pilar Storch ^{[3
]}

Benito Ruiz, Eva ^{[4
]}

Sancho Gracia, Elena ^{[4
]}

Serrano Ayestaran, Olga ^{[5
]}

Cordero Castro, Cristina ^{[6
]}

Palomino Munoz, Cecilio ^{[7
]}

Mesa Garcia, Sofia ^{[8
]}

Munoz Lopez, Cristina ^{[9
]}

Clerigue Arrieta, Nuria ^{[10
]}

Alvarez Garcia, Jorge ^{[10
]}

Cubero, Isabel ^{[11
]}

Fernandez Arribas, Jose Luis

Barasoain Millan, Alberto ^{[13
]}

Cozar Olmo, Juan Alonso ^{[14
]}

Cervera, Jose Luis Cuevas ^{[12
,14
]}

Vao Bel, Carlos Garcia ^{[15
]}

Carbonero Celis, M. Jose ^{[16
]}

Carpio Linde, M. Jose ^{[16
]}

Alonso Salas, M. Teresa ^{[17
]}

机构：

[1] Hosp Gen Univ Gregorio Maranon, Serv Urgencias Pediat, Madrid, Spain

[2] Hosp Gen Basurto, Serv Urgencias Pediat, Basurto, Spain

[3] Hosp Infantil Nino Jesus, Serv Urgencias Pediat, Madrid, Spain

[4] Hosp Infantil Miguel Servet, Serv Urgencias Pediat, Zaragoza, Spain

[5] Hosp Salamanca, Serv Urgencias Pediat, Salamanca, Spain

[6] Hosp Rey Juan Carlos, Serv Urgencias Pediat, Mostoles, Spain

[7] Hosp Getafe, Serv Urgencias Pediat, Getafe, Spain

[8] H Doce Octubre, Serv Urgencias Pediat, Madrid, Spain

[9] Hosp Infanta Leonor, Serv Urgencias Pediat, Madrid, Spain

[10] Complejo Hosp Navarra B, Serv Urgencias Pediat, Navarra, Spain

[11] Hosp Clin San Cecilio, Serv Urgencias Pediat, Granada, Spain

[12] Hosp Rio Hortega, Serv Urgencias Pediat, Valladolid, Spain

[13] Fdn Alcorcon, Serv Urgencias Pediat, Alcorcon, Spain

[14] Hosp San Agustin, Serv Urgencias Pediat, Linares, Spain

[15] Hosp Tajo, Serv Urgencias Pediat, Aranjuez, Spain

[16] Hosp Virgen Macarena, Serv Urgencias Pediat, Seville, Spain

[17] Hosp Virgen Rocio, Serv Urgencias Pediat, Seville, Spain

来源：

ANALES DE PEDIATRIA | 2019年 / 90卷 / 01期

关键词：

Sedation-analgesia procedure; Adverse drug reactions; Effectiveness; Parental satisfaction; PROCEDURAL SEDATION; ADVERSE EVENTS; NON-ANESTHESIOLOGISTS; OPERATING-ROOM; CHILDREN; KETAMINE; PEDIATRICS; MIDAZOLAM; TRIAL;

D O I：

10.1016/j.anpedi.2018.03.001

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Objectives: To offer analgesia and sedation should be a priority in paediatric emergency departments. The aim of this study was to determine the effectiveness and safety of the sedation-analgesia procedure, as well as the satisfaction of the doctors, patients and parents. Methods: A multicentre, observational, and prospective analytical study was conducted on the sedation-analgesia procedure performed on children younger than 18 years old in 18 paediatric emergency departments in Spain from February 2015 until January 2016. Results: A total of 658 procedures were recorded. The effectiveness was good in 483 cases (76.1%; 95% CI: 72.7-79.4%), partial in 138 (21.7%; 95% CI: 18.5-24.9%), and poor in 14 (2.2%; 95% CI: 1.1-3.4). The effectiveness was better when the doctor in charge was an emergency paediatrician (OR: 3.14; 95% CI: 1.10-8.95), and when a deeper level of sedation was achieved (OR: 2.37; 95% CI: 1.68-3.35). Fifty two children (8.4%) developed adverse drug reactions, more usually gastrointestinal, neurological or respiratory ones (89.9% were resolved in <2 h). One patient was intubated. The older child and a deeper level of sedation were found to be independent risk factors for adverse reactions (OR: 1.18; 95% CI: 1.09-1.28 and OR: 1.86; 95% CI: 1.22-2.83, respectively). Thirteen children (5%) developed late adverse drug reactions, more commonly, dizziness and nauseas. A combination of midazolam/ketamine had been used in all the cases (RR: 24.46; 95% CI: 11.78-50.76). The perceived satisfaction level (0-10) was obtained from 604 doctors (mean: 8.54; SD: 1.95), 526 parents (mean: 8.86; SD: 1.49), and 402 children (mean: 8.78; SD: 1.70). Conclusions: The sedation-analgesia procedure performed in paediatric emergency departments by trained paediatricians seems to be useful, effective and safe, as well as satisfactory for all participants. (C) 2017 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L.U.

引用

页码：32 / 41

页数：10

共 30 条

[1] Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department [J].

Agrawal, D ;

Manzi, SF ;

Gupta, R ;

Krauss, B .

ANNALS OF EMERGENCY MEDICINE, 2003, 42 (05) :636-646

[2]

Aldecoa V, 2006, MANUAL ANALGESIA SED, P140

[3] Consensus-Based Recommendations for Standardizing Terminology and Reporting Adverse Events for Emergency Department Procedural Sedation and Analgesia in Children [J].

Bhatt, Maala ;

Kennedy, Robert M. ;

Osmond, Martin H. ;

Krauss, Baruch ;

McAllister, John D. ;

Ansermino, J. Mark ;

Evered, Lisa M. ;

Roback, Mark G. .

ANNALS OF EMERGENCY MEDICINE, 2009, 53 (04) :426-435

[4]

Borker A, 2006, INDIAN PEDIATR, V43, P309

[5] Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016 [J].

Cote, Charles J. ;

Wilson, Stephen .

PEDIATRICS, 2016, 138 (01)

[6] Adverse sedation events in pediatrics:: Analysis of medications used for sedation [J].

Coté, CJ ;

Karl, HW ;

Notterman, DA ;

Weinberg, JA ;

McCloskey, C .

PEDIATRICS, 2000, 106 (04) :633-644

[7] Ketamine [J].

Craven, R. .

ANAESTHESIA, 2007, 62 :48-53

[8] Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: Report from the pediatric sedation research consortium [J].

Cravero, Joseph P. ;

Blike, George T. ;

Beach, Michael ;

Gallagher, Susan M. ;

Hertzog, James H. ;

Havidich, Jeana E. ;

Gelman, Barry .

PEDIATRICS, 2006, 118 (03) :1087-1096

[9] Does End Tidal CO2 Monitoring During Emergency Department Procedural Sedation and Analgesia With Propofol Decrease the Incidence of Hypoxic Events? A Randomized, Controlled Trial [J].

Deitch, Kenneth ;

Miner, Jim ;

Chudnofsky, Carl R. ;

Dominici, Paul ;

Latta, Daniel .

ANNALS OF EMERGENCY MEDICINE, 2010, 55 (03) :258-264

[10] Relief of Pain and Anxiety in Pediatric Patients in Emergency Medical Systems [J].

Fein, Joel A. ;

Zempsky, William T. ;

Cravero, Joseph P. .

PEDIATRICS, 2012, 130 (05) :E1391-E1405

← 1 2 3 →