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首页> 外文期刊>Canadian Journal of Emergency Medicine >Procedural sedation by advanced care paramedics for emergency gastrointestinal endoscopy
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Procedural sedation by advanced care paramedics for emergency gastrointestinal endoscopy

机译：急诊胃肠道内窥镜检查由高级护理护理人员进行的镇静

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ObjectivesAt the QEII Health Sciences Centre Emergency Department (ED) in Halifax, Nova Scotia, advanced care paramedics (ACPs) perform procedural sedation and analgesia (PSA) for many indications, including orthopedic procedures. We have begun using ACPs as sedationists for emergent upper gastrointestinal (UGI) endoscopy. This study compares ACP-performed ED PSA for UGI endoscopy and orthopedic procedures in terms of adverse events, airway intervention, vasopressor requirement, and PSA medication use.MethodsA data set was built from an ED PSA quality control database matching 61 UGI endoscopy PSAs to 183 orthopedic PSAs by propensity scores calculated using age, gender, and the American Society of Anesthesiologists (ASA) classification. Outcomes assessed were hypotension (systolic BP&100 mm Hg or a 15% decrease from baseline), hypoxia (SaO2&90%), apnea (&30 sec), vomiting, arrhythmias, death, airway intervention, vasopressor requirement, and PSA medication use.ResultsUGI endoscopy patients experienced hypotension more frequently than orthopedic patients (OR=4.11, CI: 2.05-8.22) and required airway repositioning less often (OR=0.24, CI: 0.10-0.59). They received ketamine more frequently (OR=15.7, CI: 4.75-67.7) and fentanyl less often (OR=0.30, CI: 0.15-0.63) than orthopedic patients. Four endoscopy patients received phenylephrine, and one required intubation. No patient died in either group.ConclusionsIn ACP-led sedation for UGI endoscopy and orthopedic procedures, adverse events were rare with the notable exception of hypotension, which was more frequent in the endoscopy group. Only endoscopy patients required vasopressor treatment and intubation. We provide preliminary evidence that ACPs can manage ED PSA for emergent UGI endoscopy, although priorities must shift from pain control to hemodynamic optimization.
机译：目标在新斯科舍省哈利法克斯的QEII健康科学中心急诊科（ED），高级护理护理人员（ACP）对包括骨科手术在内的许多适应症进行程序镇静和镇痛（PSA）。我们已经开始将ACP用作镇静剂，用于新兴的上消化道（UGI）内窥镜检查。本研究从不良事件，气道干预，血管加压药需求和PSA药物使用等方面比较了ACP执行的ED PSA用于UGI内窥镜检查和整形外科手术的方法。骨科PSA通过使用年龄，性别和美国麻醉医师学会（ASA）分类计算的倾向评分来计算。评估的结果是低血压（收缩压<100 mm Hg或比基线降低15％），低氧（SaO 2 ＜90％），呼吸暂停（> 30秒），呕吐，心律不齐，死亡，气道干预，血管加压药和PSA结果UGI内窥镜检查患者发生低血压的频率高于整形外科患者（OR = 4.11，CI：2.05-8.22），而需要进行气道重新定位的频率降低（OR = 0.24，CI：0.10-0.59）。与整形外科患者相比，他们接受氯胺酮的频率更高（OR = 15.7，CI：4.75-67.7），而芬太尼的频率更低（OR = 0.30，CI：0.15-0.63）。四名内窥镜检查患者接受了去氧肾上腺素，一名需要插管。两组均无患者死亡。结论在ACP引导的UGI内窥镜和骨科手术中，除低血压外，不良事件很少见，内窥镜组更为常见。仅内窥镜检查患者需要血管加压药治疗和插管。我们提供了初步的证据，尽管优先级必须从疼痛控制转向血流动力学优化，但ACP可以为急诊UGI内镜治疗ED PSA。

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