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Unconscious sedation in children: a prospective multi-arm clinical trial
Loren A Bauman1, Michael L Cannon, John McCloskey
1Department of Anesthesiology, Section of Pediatric Anesthesiology and Critical Care Medicine, Wake Forest University School of Medicine, Winston Salem, NC 27157, USA. lbauman@wfubmc.edu
Insights
The combination of methohexital and remifentanil offers effective deep sedation for children during painful procedures. This method demonstrated faster recovery times and comparable safety to propofol and fentanyl combinations.
Area of Science:
- Pediatric Anesthesiology
- Pharmacology
- Sedation Management
Background:
- Evaluating sedative-analgesic combinations for pediatric procedural sedation.
- Focus on achieving deep or unconscious sedation in children.
- Addressing the need for safe and effective sedation in brief, painful procedures.
Purpose of the Study:
- To assess the efficacy and safety of six sedative-hypnotic and analgesic combinations.
- To compare propofol and methohexital with fentanyl and remifentanil.
- To identify optimal drug combinations for pediatric procedural sedation.
Main Methods:
- Prospective, open-label, randomized controlled study.
- Six groups of 27-30 children each.
- Random assignment to propofol or methohexital with varying doses of fentanyl or remifentanil.
Main Results:
- Methohexital combined with remifentanil showed significantly shorter emergence and discharge times.
- This combination required airway interventions not significantly more frequent than propofol/fentanyl groups.
- Identified methohexital and remifentanil as a promising combination.
Conclusions:
- Methohexital and remifentanil combination is a satisfactory method for unconscious sedation.
- Suitable for short, painful pediatric procedures.
- Offers a potentially improved sedation profile compared to other tested combinations.
Background:
We report the evaluation of six sedative-hypnotic and analgesic combinations administered to children undergoing brief periods of unconscious (or deep) sedation for painful procedures.
Methods:
In a prospective, open-label, randomized, controlled study of six groups of 27-30 children each, patients were randomly assigned to receive propofol or methohexital for sedation-hypnosis, and one of three incremental doses of fentanyl or remifentanil, respectively.
Results:
An infusion of methohexital (10 mg.ml-1) combined with remifentanil (6.67 micro g.ml-1) provided significantly shorter geometric mean times to initial emergence, to eye-opening and to discharge, and required airway interventions that were not significantly more frequent than all groups sedated with propofol and fentanyl.
Conclusions:
The combination of methohexital and remifentanil appears to be a satisfactory method for unconcious sedation for short painful procedures in children.