程序性镇静和镇痛(PSA)是急诊科(ED)的常见做法,旨在减轻疼痛,焦虑,以及各种医疗程序中的不适。我们进行了系统评价和荟萃分析,目的是评估与PSA相关的不良事件的发生率。包括与单个药物和各种药物组合有关的药物。该研究遵循PRISMA指南,对ED镇静不良事件进行系统评价和荟萃分析。在十个数据库中采用了全面的搜索策略,补充了clinicaltrials.gov上的搜索和参考列表的手动审查。数据提取的重点是药物管理和不良事件。该研究考虑了四种类型的不良事件:心脏,呼吸,胃肠,和神经学。仅包括针对ED设置中的成年患者的PSA的随机对照试验(RCT)。统计分析采用OpenMeta分析师进行单臂荟萃分析,结果与相应的95%置信区间一起呈现。森林地块的建设是为了结合和评估结果,并进行敏感性分析以确定异质性的来源。从4246条记录的文献检索中,32项随机对照试验被认为适用于这项荟萃分析。分析包括6377次程序镇静。最常见的不良事件是缺氧,发生率为78.5/1000次镇静(95%CI=77.5-133.5)。接着是呼吸暂停和低血压,每1000次镇静的发生率为31次(95%CI=19.5-41.8)和28.1次(95%CI=17.4-38.9),分别。躁动和呕吐均发生在每1,000次镇静中15.6次(95%CI=8.7-22.6)。严重不良事件很少见,在每1000次镇静中观察到16.7次心动过缓,每1,000次镇静中有2.9次喉痉挛(95%CI=-0.1至6),插管为10.8/1000次镇静(95%CI=4-17),和每1000次镇静中有2.7次吸入(95%CI=-0.3至5.7)。就呼吸道不良事件而言,氯胺酮被认为是最安全的选择,呼吸暂停和缺氧的发生率最低,使其成为被评估药物中呼吸抑制剂最少的药物。单独使用时,依托咪酯的低血压发生率最低。丙泊酚单独使用时低血压的发生率最高,在缺氧相关不良事件中排名第二,仅次于咪达唑仑。使用镇静剂的组合,比如异丙酚和氯胺酮,已经发现比单一药物有几个优点,尤其是减少呕吐等不良事件,插管困难,低血压,心动过缓,和喉痉挛.与单独使用异丙酚或氯胺酮相比,该组合显着降低了低血压的发生率。尽管经常使用程序性镇静剂,它有时会导致严重的不良事件。呼吸暂停和缺氧等呼吸问题,虽然不常见,确实比低血压等心血管问题更常见。然而,最不常见的呼吸系统并发症,这也会对生命构成威胁,包括喉痉挛,抽吸,和插管。这些事件极为罕见。
Procedural sedation and analgesia (PSA) are a common practice in emergency departments (EDs), aiming to alleviate pain, anxiety, and discomfort during various medical procedures. We have undertaken a systematic
review and meta-analysis with the aim of assessing the incidence of adverse events associated with PSA, including those related to individual drugs and various drug combinations. The study adhered to PRISMA guidelines for a systematic
review and meta-analysis of adverse events in ED sedation. A comprehensive search strategy was employed across ten databases, supplemented by searches on clinicaltrials.gov and manual reviews of reference lists. Data extraction focused on medication administration and adverse events. The study considered four types of adverse events: cardiac, respiratory, gastrointestinal, and neurological. Only randomized controlled trials (RCTs) focusing on PSA administered to adult patients within the ED setting were included. The statistical analysis employed OpenMeta Analyst to conduct a one-arm meta-analysis, with findings presented alongside their corresponding 95% Confidence Intervals. Forest plots were constructed to combine and evaluate results, and sensitivity analyses were performed to identify sources of heterogeneity. From a literature search of 4246 records, 32 RCTs were deemed suitable for this meta-analysis. The analysis included 6377 procedural sedations. The most common adverse event was hypoxia, with an incidence rate of 78.5 per 1000 sedations (95% CI = 77.5-133.5). This was followed by apnea and hypotension, with incidence rates of 31 (95% CI = 19.5-41.8) and 28.1 (95% CI = 17.4-38.9) per 1,000 sedations, respectively. Agitation and vomiting each occurred in 15.6 per 1,000 sedations (95% CI = 8.7-22.6). Severe adverse events were rare, with bradycardia observed in 16.7 per 1,000 sedations, laryngospasm in 2.9 per 1,000 sedations (95% CI = - 0.1 to 6), intubation in 10.8 per 1,000 sedations (95% CI = 4-17), and aspiration in 2.7 per 1,000 sedations (95% CI = - 0.3 to 5.7). Ketamine is found to be the safest option in terms of respiratory adverse events, with the lowest rates of apnea and hypoxia, making it the least respiratory depressant among the evaluated drugs. Etomidate has the least occurrence of hypotension when used alone. Propofol has the highest incidence of hypotension when used alone and ranks second in hypoxia-related adverse events after midazolam. Using combinations of sedating agents, such as propofol and ketamine, has been found to offer several advantages over single drugs, especially in reducing adverse events like vomiting, intubation difficulty, hypotension, bradycardia, and laryngospasm. The combination significantly reduces the incidence of hypotension compared to using propofol or ketamine individually. Despite the regular use of procedural sedation, it can sometimes lead to serious adverse events. Respiratory issues like apnea and hypoxia, while not common, do occur more often than cardiovascular problems such as hypotension. However, the least frequent respiratory complications, which can also pose a threat to life, include laryngospasm, aspiration, and intubation. These incidents are extremely rare.