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鼻内注射右美托咪啶、咪达唑仑和氯胺酮在儿科门诊手术中的镇静作用比较：一项随机临床试验
贵州医科大学 麻醉与心脏电生理课题组
翻译：赵游宵 编辑：王婷婷 审校：曹莹
背景：儿科患者术前焦虑的管理及其影响对于麻醉科医生来说仍然具有挑战性。 在这项研究中，我们比较了鼻内右美托咪定、咪达唑仑和氯胺酮作为儿童手术前用药的安全性和有效性。
方法：这项双盲随机临床试验于2014年1月在两家三级医院进行，受试者为90名2-7岁儿童。参与者的美国麻醉医师协会（ASA）身体状况为I或II，并计划择期进行单侧腹股沟疝修补术。采用分组随机法，将患者随机分为三组，每组在麻醉诱导前60 min鼻内滴注右美托咪定（2 μg/Kg）、咪达唑仑（0.2 mg/Kg）和氯胺酮（8 mg/Kg）。在给药前评估焦虑和镇静状态，然后在接下来的 50 分钟内每 10 分钟评估一次。还记录并比较各组之间的父母分离焦虑、面罩接受度、术后躁动、疼痛、恶心和呕吐。所有统计分析均使用SPSS软件（21.0版）进行。 P<0.05被认为有统计学意义。
结果：氯胺酮在术前用药后10、20、30 min镇静作用最强（分别为P<0.001、P=0.03、P=0.01）。然而，40分钟和50分钟后，右美托咪定比其他药物更有效（P<0.001）。其他变量表明没有统计学上的显着差异。
结论：在紧急情况下，可采用滴鼻氯胺酮，作用时间最短。 鼻内右美托咪定被认为是本研究中最有效的药物，可以在择期儿科手术前 40-50 分钟给药。
原始文献：Azemati, S., Keihani, M., Sahmeddini, M. A., Nejad, F. K., Dehghanpisheh, L., Khosravi, M., & Asmarian, N. (2024). Comparing the Sedative Effects of Intranasal Dexmedetomidine, Midazolam, and Ketamine in Outpatient Pediatric Surgeries: A Randomized Clinical Trial. Iranian Journal of Medical Sciences, 49, 421–429. https://doi.org/10.30476/ijms.2023.99122.3118
Comparing the Sedative Effects of Intranasal Dexmedetomidine, Midazolam, and Ketamine in Outpatient Pediatric Surgeries: A Randomized Clinical Trial
Background: The management of preoperative anxiety in pediatric patients, as well as its implications, has remained challenging for anesthesiologists. In this study, we compared the safety and efficacy of intranasal dexmedetomidine, midazolam, and ketamine as surgical premedication in children.
Methods: This double-blinded randomized clinical trial was conducted at two tertiary hospitals in January 2014, on 90 children aged between 2-7 years old. The participants’American Society of Anesthesiologists (ASA) physical status was I or II, and they were scheduled for elective unilateral inguinal herniorrhaphy. Using the block randomization method, the patients were randomly assigned to three groups, each receiving intranasal dexmedetomidine (2 μg/Kg), midazolam (0.2 mg/Kg), and ketamine (8 mg/Kg) 60 min before induction of anesthesia. Anxiety and sedation state were evaluated before drug administration, and then every 10 min for the next 50 min. Parental separation anxiety, mask acceptance, postoperative agitation, pain, nausea, and vomiting were also recorded and compared between these groups. All the statistical analyses were performed using SPSS software (version 21.0). P<0.05 was considered statistically significant.
Results: Ketamine indicated the strongest sedative effect 10, 20, and 30 min after administration of premedication (P<0.001, P=0.03, P=0.01, respectively). However, dexmedetomidine was more effective than other drugs after 40 and 50 min (P<0.001). Other variables indicated no statistically significant difference.
Conclusion: In case of emergencies, intranasal ketamine, with the shortest time of action, could be administered. Intranasal dexmedetomidine, which was revealed to be the most potent drug in this study, could be administrated 40-50 min before elective pediatric surgeries.
