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子どもの上部消化器内視鏡における麻酔剤に関するランダム化制御試験の包括的な体系的レビュー:安全性の懸念と有効性の強調
Amr Elrosasy1, Mahmoud Diaa Hindawi2, Mohamed Abo Zeid3,4
1Faculty of Medicine, Cairo University, Cairo, Egypt.
Naunyn-Schmiedeberg's archives of pharmacology
|September 4, 2025
まとめ
小児上部消化器内視鏡 (GIE) の鎮静作用は様々です. レミマゾラムは最も早く回復し,S- ケタミンは投与量に依存する効果があります. 個別選択は安全で効果的な小児GIE鎮静の鍵です.
科学分野:
- 小児胃腸内科
- 麻酔科
- 薬理学について
背景:
- 上部胃腸内視鏡検査 (GIE) は,小児の胃腸疾患の診断と治療に不可欠です.
- 患者の不快感や痛みのために,小児GIEでは通常,鎮静剤が必要です.
- 鎮静剤の投与量を最適化することは 患者の安全と処置の効率化に不可欠です
研究 の 目的:
- 6~12歳児における上部GIEに対する異なる鎮静剤投与を比較したランダム化対照試験 (RCT) を体系的に検討する.
- 様々な鎮静剤に関連した回復時間,血液動力学的パラメータ,および有害事象を評価し,比較する.
主な方法:
- 主要データベース (PubMed,Web of Science,Scopus,Ovid) のRCTを 2024年3月30日までにPRISMA 2020に準拠した体系的にレビューする.
- 含有基準:上部GIEを受けた子供の鎮静剤 (プロポフール,ケタミン,レミサゾラム,デクスメドトミジン) を比較したRCT
- Cochrane ROB-2を用いてバイアスのリスクを評価し,データを記述的かつ定量的に合成した.
主要な成果:
- 1955人の患者を対象とした19件のRCTが含まれており,プロポポールの併用は一般的であった.
- プロポフォール・ケタミンはプロポフォール・フェンタニルよりも血液動力学的安定性を示した. S- ケタミンは用量依存の回復とめまいを示した.
- レミマゾラムは最速の回復を示した. レミマゾラムとデクスメデトミディンの治療法は合併症が少ないが,低血圧のモニタリングが必要であった.
結論:
- 小児上部GIEの鎮静薬療法は,有効性と安全性プロファイルで大きく異なります.
- レミマゾラムは迅速な回復をもたらしますが,S-ケタミンの神経学的効果は慎重に投与する必要があります.
- 患者の要因と望ましい結果を考慮して,鎮静剤の個別の選択が推奨されます.
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