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Intravenous Thiamylal and Local Anesthetic Infiltration for Pediatric Facial Repair Procedures Performed in Emergency Departments

以靜脈Thiamylal合併局部麻醉劑浸潤應用於急診小兒臉部修復處置之回溯性研究

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摘要


Thiamylal是急診常用於處置過程鎮靜的用藥,惟其較高劑量(>5mg/kg)用於兒童的安全性報告有限。本研究的目的為評估於急診使用thiamylal作為兒童輕至中度鎮靜劑的療效與其劑量增加和副作用出現的關連性。回朔性的蒐集由2004年7月至2008年6月的五年內,前往市郊一所教學綜合醫院急診處進行小型侵入性手術的227位病童的資料,本研究評估了靜脈投予thiamylal,合併使用局部麻醉劑浸潤的安全性與有效性。105(46%)位男性與122(54%)位女性病童中,臉部撕裂傷的侵入性手術處置為使用鎮靜劑的主因。所有的病童都先接受thiamylal 5mg/kg作為初始劑量,其中81(35.68%)位因鎮靜作用不夠再接受了thiamylal 2.5mg/kg的追加劑量;這81位中又有27(11.89%)位仍因鎮靜作用不夠而再接受了一次thiamylal 2.5mg/kg的追加劑量。結果顯示,66(29.07%)位病童出現了75項輕微且不需緊急處置或用藥的副作用;其中,困倦(20%)為最常出現的副作用。有4位病童曾出現血氧濃度低於96%且此與劑量追加有關(p=0.002),但完全沒有病童出現嚴重的副作用,亦沒有病童出現嚴重的併發症。這些結果顯示了在急診給予需要侵入性治療的病童靜脈投予thiamylal且合併使用局部麻醉劑浸潤是安全的,thiamylal提供了作用迅速與維持平穩心肺功能的優點。

關鍵字

急診 小兒 處置過程鎮靜 thiamylal

並列摘要


Thiamylal is widely used for procedural sedation in emergency departments (ED); however, there are limited safety data for doses of thiamylal>5 mg/kg in children. We investigated whether intravenous thiamylal in combination with local anesthetics is safe and effective for pediatric procedural sedation in the ED and to identify the association between increasing doses thiamylal and adverse events. Between July 2004 and June 2008, 227 children who underwent procedural sedation met the inclusion criteria, including 105 males (46.3%) and 122 females (53.7%). Facial laceration was the most common indication for procedural sedation. All children received an intravenous injection of thiamylal, with a loading dose of 5 mg/kg. Eighty-one children (35.7%) received a supplemental dose of 2.5 mg/kg thiamylal because of inadequate sedation. Of these, 27 (11.9%) received a second supplemental dose of 2.5 mg/kg because of inadequate sedation. Sixty-six patients (29.1%) experienced 75 mild and self-resolving adverse events, and most of which (15/75; 20%) were drowsiness. Four (1.8%) patients experienced oxygen saturation below 96%, which was related to the supplemental dose of thiamylal (p=0.002). No children suffered from any lasting or potentially serious complications. Our results indicate that intravenous thiamylal in combination with local anesthetic infiltration is a well tolerated for therapeutic procedures in the ED. Thiamylal offers rapid onset of sedation without compromising the patient's cardiorespiratory function during pediatric procedural sedation.

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