PDF(Pubmed)
Abstract：
Sedation is a depression of a patient\'s state of consciousness, induced by medications, that can reach different levels of intensity during a medical procedure. Conscious sedation produces a minimally depressed level of consciousness without impairment of the ability to maintain an open airway, of protective reflexes or of responses to verbal and physical stimulation. This umbrella review is aimed at critically assessing the available systematic reviews (SRs) and meta-analyses (MA) on sedation in children/adolescents. An electronic database search was conducted that included Pubmed-Medline, Web of Science, Cochrane, Scopus, Scielo, Embase, LILACS and TRIP and the scope of which extended until January 2023. The risk of bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). Of 998 entries, 37 SRs were included. In terms of methodological quality, eight studies were assessed as having critically low quality, four studies had low quality, nine studies had moderate quality, and sixteen were considered to be of high quality. Based on the current guidelines, the most employed drugs in pediatric dentistry for sedation are nitrous oxide and midazolam; however, the available evidence supporting their use is insufficient and of low/critically low quality. The combined technique is recommended (nitrous oxide (30-50%) + midazolam). The optimal dose of oral midazolam is 0.75 mg/kg. The level of methodological quality of SRs is expected to increase according to the results and future directions of this umbrella review.
摘要：
镇静是患者意识状态的抑郁，药物诱导，在医疗过程中可以达到不同的强度。清醒镇静产生最低限度的意识水平，而不损害维持开放气道的能力，保护性反射或对言语和身体刺激的反应。本综述旨在严格评估儿童/青少年镇静的系统评价（SRs）和荟萃分析（MA）。进行了电子数据库搜索，其中包括Pubmed-Medline，WebofScience,科克伦,Scopus,Scielo,Embase,LILACS和TRIP，其范围延长至2023年1月。使用测量工具评估SRs标准2（AMSTAR2）分析SRs的偏倚风险（RoB）。在998个条目中，包括37个SR。在方法质量方面，八项研究被评估为质量极低，四项研究质量低，九项研究质量中等，16个被认为是高质量的。根据目前的指导方针，儿科牙科中使用最多的镇静药物是一氧化二氮和咪达唑仑；然而，支持其使用的现有证据不足，质量低/严重低。推荐使用组合技术（一氧化二氮（30-50％）咪达唑仑）。口服咪达唑仑的最佳剂量为0.75mg/kg。根据本次总括性审查的结果和未来方向，预计SRs的方法学质量水平将有所提高。
