| Background:In the outpatient clinic,due to the influence of psychological and physiological factors such as low pain tolerance and sensitivity to the hospital environment,children often have negative emotions such as anxiety,irritability and fear,and are often crying to refuse the examinations and treatments.It has become the biggest obstacle in pediatric diagnosis and treatment.Therefore,in order to ensure the emotional stability of children and the possibility to cooperate,sedatives and other means are usually used to ensure the accuracy of diagnosis and the effect of treatment.The main sedative drugs in pediatric outpatient department are chloral hydrate,benzodiazepine,ketamine,inhalation anesthetics,intravenous anesthetics and dexmetomidine(DEX)and so on.Among them,propofol and DEX are relatively close to the ideal sedative drugs.Particularly,DEX nasal drops no venipuncture and high compliance is more and more widely used in clinic and in outpatient pediatric sedation.In recent years,some scholars have used DEX nasal drops for sedation in children who need MRI,CT and echocardiography examination,but no research on the relationship between DEX sedation and children’s recovery is found.Objective:The purpose of this study was to explore sedative effect of 2.5 μ g/kg and 3.0 μg/kg DEX intranasal drip and the factors related to the recovery in the examination of heart color Doppler echocardiography in children,and to choose a more reasonable clinical sedation scheme.Methods:A total of 111 children aged 1 to 36 months from Huai’an Maternity and Child Health Hospital with intranasal DEX sedation during the examination Doppler echocardiography were selected.They were randomly divided into two groups: D1group(n=57)and D2 group(n=54).2.5 μg/kg and 3.0 μg/kg DEX nasal drops were given in D1 group and D2 group.The two groups of children were divided into two age subgroups according to the age of less than or equal to 12 months and more than12 months.The heart rate,pulse oxygen saturation before and after sedation were recorded by a nurse anesthetist who did not know the study design.The onset time,recovery time and adverse reactions were recorded.After intranasal administration,the onset time was achieved when Ramsay score reached 5 points,and the recovery time was defined when aldrete score reached 9 points.The sedation time was also recorded.After nasal drip,the child fell asleep smoothly,the echocardiography probe was placed under the xiphoid process and on the sternum,and the child had no body movement reaction.During the echocardiography examination,no mechanical restraint was used.The successful completion of transthoracic echocardiography was regarded as successful sedation.If a sufficient depth of sedation is not achieved within 45 minutes after a single administration;physical movement that cannot be completed for examination occurs;severe side effects or adverse events occur;or children who are given a remedial dose are excluded.The onset time,sedation time,sedation success,signs and adverse reactions were compared between the two groups;At the same time,the two groups were compared in age less than or equal to 12 months and older than 12 months,which compared the onset time and sedation time;With age,body weight,sex,fasting time and onset time as independent variables and sedation time as dependent variables.Multiple linear regression equations were established to explore the influencing factors related to awakening and choose a more reasonable clinical sedation scheme.Results:1.The success rate of one-time sedation was 98% in D1 group and 100% in D2 group,and there was no significant difference between the two groups.In the D1 group,2 children were additionally given DEX 1 μ g/kg during examination after one-time sedation,so they were excluded.There were 55 cases subsequently enrolled in group D1.There were no statistically significant differences in age,weight,gender or fasting time between the D1 and D2 groups(P>0.05).2.There was no significant difference in the onset time after one-dose DEX given between D1 and D2 groups(P > 0.05),but the sedation time in D2 group was significantly longer than that in D1 group(P < 0.05).There was no significant difference in the heart rate and pulse oxygen saturation at each time point,and incidence of adverse reactions(P > 0.05).3.The sedation time in the age less than 12 months group was significantly longer than that in the age > 12 months group(P < 0.05).4.Body weight had a significant negative effect on the sedation time.Conclusion:1.Compared with 3.0 μ g / kg,2.5 μ g / kg DEX one dose given nasal drip for color Doppler echocardiography in children can provide similar sedation effect,and awake soon as well.Therefore,intranasal DEX 2.5 μg/kg is more recommended,but there is a certain rate of remediation.2.The sedation time is negatively correlated with their body weight,and age can be used as a reference for drug administration.For infants under 1 year old,recovery is significantly prolonged. |
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