咪达唑仑口服溶液用于门诊患儿全麻下根管治疗术前镇静的效果

Efficacy of oral midazolam solution for preoperative sedation in pediatric outpatients undergoing root canal treatment under general anesthesia

目的评价咪达唑仑口服溶液用于门诊患儿全麻下根管治疗术前镇静的效果。方法拟行门诊全麻下根管治疗的患儿147例,性别不限,年龄2~7岁,体质量10~30 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为3组(n=49):咪达唑仑口服溶液组(OM组)、咪达唑仑注射液组(M组)和右美托咪定组(D组)。OM组口服咪达唑仑口服溶液0.5 mg/kg+安慰剂(按照体重计算的等量生理盐水)滴鼻,M组口服咪达唑仑注射液0.5 mg/kg+安慰剂滴鼻,D组口服安慰剂+右美托咪定2μg/kg滴鼻。记录入室后诱导期依从性量表(ICC)评分、镇静良好(ICC评分≤3分)情况、药物接受度评分、面罩接受度评分和分离焦虑评分。记录苏醒时间、PACU停留时间和术中、PACU期间心动过缓、低血压、低氧血症、喉痉挛等发生情况。结果最终纳入143例患儿,OM组和M组各48例,D组47例。与M组和D组相比,OM组入室时ICC评分降低,镇静良好率升高,药物接受度评分升高,分离焦虑评分降低,面罩接受度评分降低(P<0.05);与D组相比,M组入室时ICC评分降低,镇静良好率升高,面罩接受度评分降低(P<0.05)。3组苏醒时间、PACU停留时间、术中和PACU期间不良反应发生率比较差异无统计学意义(P>0.05)。结论咪达唑仑口服溶液用于门诊患儿全麻下根管治疗术前镇静的效果好,不良反应少。

Objective To evaluate the efficacy of oral midazolam solution for preoperative sedation in the pediatric outpatients undergoing root canal treatment under general anesthesia.Methods One hundred and forty-seven pediatric patients of either sex,aged 2-7 yr,weighing 10-30 kg,of American Society of Anesthesiologists Physical Status classificationⅠorⅡ,were divided into 3 groups(n=49 each)using a random number table method:oral midazolam solution group(OM group),midazolam injection group(M group),and dexmedetomidine group(D group).In OM group,patients received oral midazolam solution at a dose of 0.5 mg/kg along with a placebo(an equivalent amount of normal saline based on body weight)administered via nasal drops.In M group,patients were given oral midazolam injection at a dose of 0.5 mg/kg along with a placebo via nasal drops.In D group,patients were administered a placebo orally along with dexmedetomidine at a dose of 2μg/kg via nasal drops.The Induction Compliance Checklist(ICC)scores upon entering the operating room,sedation success rates(ICC score≤3),drug acceptance scores,mask acceptance scores,and separation anxiety scores were recorded.The emergence time,time of stay in postanesthesia care unit(PACU),and occurrence of adverse events such as bradycardia,hypotension,hypoxemia,and laryngospasm during surgery and in PACU were recorded.Results A total of 143 pediatric patients were finally included in the study,with 48 cases in OM group,48 cases in M group and 47 cases in D group.Compared with M and D groups,the ICC scores upon entry to the operating room were significantly decreased,the sedation success rates were increased,drug acceptance scores were increased,separation anxiety scores were decreased,and mask acceptance scores were decreased in OM group(P<0.05).Compared with D group,the ICC scores upon entry to the operating room were significantly decreased,the sedation success rates were increased,and mask acceptance scores were decreased in M group(P<0.05).There were no statistically significant differences in the emergence time,time of stay in PACU,and incidence of adverse events during surgery and in PACU among the three groups(P>0.05).Conclusions Oral midazolam solution provides good effect with less adverse reactions when used for preoperative sedation in the pediatric outpatients undergoing root canal treatment under general anesthesia.