Abstract：
Background: Advancements in palliative surgery of patients with single ventricle physiology have led to an increase in the need for deep sedation protocols for painful procedures. However, positive pressure ventilation during anesthesia can result in unfavorable cardiopulmonary interactions. This patient population may benefit from sedation from these painful procedures. Methods: This study aims to demonstrate the safety and efficacy of deep sedation by pediatric intensivists outside the operating room for children with single ventricle physiology. This is a single-center, retrospective chart review on consecutive pediatric patients with single ventricle physiology who received deep sedation performed by pediatric intensivists between 2013 and 2020. Results: Thirty-three sedations were performed on 27 unique patients. The median age was 3.7 years (25th%-75th%: 2.1-15.6). The majority of the sedations, 88% (29/33), were done on children with Fontan physiology and 12% (4/33) were status-post superior cavopulmonary anastomosis. The primary cardiac defect was hypoplastic left heart in 63% (17/27) of all sedation procedures. There were 24 chest tube placements and 9 cardioversions. Ketamine alone [median dose 1.5 mg/kg (range 0.8-3.7)], ketamine [median dose 1 mg/kg (range 0.1-2.1)] with propofol [median dose 2.3 mg/kg (range 0.7-3.8)], and ketamine [median dose 1.5 mg/kg (range 0.4-3.0)] with morphine [median dose 0.06 mg/kg (range 0.03-0.20)] were the most common sedation regimens used. Adverse events (AEs) occurred in 4 patients (15%), three of which were transient AEs. All sedation encounters were successfully completed. Conclusion: Procedural deep sedation can be safely and effectively administered to single ventricle patients by intensivist-led sedation teams in selective case.
摘要：
背景：单心室生理学患者姑息性手术的进步导致对疼痛手术的深度镇静方案的需求增加。然而,麻醉期间的正压通气可导致不利的心肺相互作用。该患者群体可受益于这些疼痛程序的镇静。方法：本研究旨在证明手术室外儿科重症医师对单心室生理患儿进行深度镇静的安全性和有效性。这是一个单一的中心，回顾性图表回顾了2013年至2020年间接受儿科重症监护医师深度镇静的单心室生理的连续儿科患者.结果：对27例独特患者进行了33次镇静。中位年龄为3.7岁（25％-75％：2.1-15.6）。大部分的镇静剂,88%（29/33），对患有Fontan生理的儿童进行了手术，12％（4/33）是上腔肺吻合术后的状态。在所有镇静程序中，有63％（17/27）的原发性心脏缺陷是左心发育不良。有24例胸管放置和9例心脏复律。单独使用氯胺酮[中位剂量1.5mg/kg（范围0.8-3.7）]，氯胺酮[中位剂量1mg/kg（范围0.1-2.1）]与异丙酚[中位剂量2.3mg/kg（范围0.7-3.8）]，氯胺酮[中位剂量1.5mg/kg(范围0.4-3.0)]和吗啡[中位剂量0.06mg/kg(范围0.03-0.20)]是最常用的镇静方案.4例患者（15%）发生不良事件（AE），其中三个是短暂的AE。成功完成了所有镇静任务。结论：在选择性病例中，重症医师主导的镇静小组可以安全有效地对单心室患者进行程序性深度镇静。
