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【罂粟摘要】异丙酚用于小儿程序性镇静的年龄分层剂量

2023-05-27 10:50

本研究发现,在小儿程序性镇静中,异丙酚的诱导和维持剂量与年龄成反比。此外,婴儿和学步期儿童需要的异丙酚镇静剂量明显高于预期和先前的报道。

异丙酚用于小儿程序性镇静的年龄分层剂量

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贵州医科大学    麻醉学与心脏电生理课题组

翻译:柏雪

编辑:宋雨婷

审校:曹莹

背景

用于诊断和微创治疗中的程序性镇静和镇痛 (PSA) 已广泛应用到所有年龄段儿童。基于此前的临床经验,我们认为年龄和剂量之间存在反比关系。然而,PSA按年龄分层的异丙酚诱导剂量和维持剂量尚不明确,但它可为许多麻醉医生提供用量参考。

方法

该研究对2007年6月至2020年12月在乌得勒支大学医学中心(UMCU)的三级儿科医院 Wilhelmina 儿童医院 (WKZ)接受程序性镇静的儿童进行了回顾性队列研究。使用线性回归模型分析诱导剂量(mg/kg)和维持剂量(mg/kg·h)是否与年龄有关。

从麻醉信息管理系统 (AIMS) 中检索到6438 个儿科手术记录。共有 5567 条记录可用于诱导剂量分析,5420 条记录可用于维持剂量分析。在对性别、ASA分级、阿片类药物给药以及诊断或介入治疗进行调整后,从异丙酚诱导剂量(mg/kg)的多变量线性回归模型中获得了年龄(年)的系数为−0.11(95%置信区间[CI],−0.12至−0.11),异丙酚维持剂量的系数为−0.36 (95% CI,−0.39至−0.34)。

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结论

本研究发现,在小儿程序性镇静中,异丙酚的诱导和维持剂量与年龄成反比。此外,婴儿和学步期儿童需要的异丙酚镇静剂量明显高于预期和先前的报道。

原始文献来源:

Huib van Dijk, MD, Mark P . Hendriks, MD, Marga M. van Eck-Smaling, BSc, Leo van Wolfswinkel, MD, PhD, and Kim van Loon, MD, PhD. Age-Stratified Propofol Dosage for Pediatric Procedural Sedation and Analgesia. Pediatric Anesthesiology.

英文原文

Age-Stratified Propofol Dosage for Pediatric Procedural Sedation and Analgesia

Background: Procedural sedation and analgesia (PSA) for diagnostic and minimally invasive therapeutic procedures has become common practice in children of all ages. Based on our clinical experience, we suspected an inverse relation between age and dosage. However, a schedule for age-stratified propofol induction and maintenance dosage for PSA was not available and could be helpful to many anesthesiologists as a reference.

Methods: We performed a retrospective cohort study of children who received procedural sedation at the Wilhelmina Children’ s Hospital (WKZ), a tertiary pediatric hospital part of the University Medical Center Utrecht (UMCU), between June 2007 and December 2020. We studied whether the induction (mg·kg−1) and maintenance (mg·kg−1·h−1) dosage is age-dependent using linear regression models.

Results: A total of 6438 pediatric procedures were retrieved from Anesthesia Information Management Systems (AIMS). A total of 5567 records were available for induction dose analysis and 5420 records for analysis of the maintenance dose. After adjustment for sex, American Society of Anesthesiologists (ASA) physical status classification, opioid administration, and diagnostic or interventional, we obtained a coefficient of −0.11 (95% confidence interval [CI], −0.12 to −0.11) for age (years) from a multivariable linear regression model for propofol induction dosage (mg·kg−1) and a coefficient of −0.36 (95% CI, −0.39 to −0.34) for age (years) for propofol maintenance dosage.

Conclusions: We found a noteworthy inverse age-effect on propofol dosage for both induction and maintenance of pediatric procedural sedation. Furthermore, our study revealed that remarkably higher propofol sedation doses were needed for infants and toddlers than previously expected and reported.

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