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首页> 外文期刊>Canadian Journal of Emergency Medicine >Between- and within-site variation in medication choices and adverse events during procedural sedation for electrical cardioversion of atrial fibrillation and flutter
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Between- and within-site variation in medication choices and adverse events during procedural sedation for electrical cardioversion of atrial fibrillation and flutter

机译：心房颤动和扑动电复律的镇静过程中药物选择和不良事件的现场之间和现场变化

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ObjectivesAlthough procedural sedation for cardioversion is a common event in emergency departments (EDs), there is limited evidence surrounding medication choices. We sought to evaluate geographic and temporal variation in sedative choice at multiple Canadian sites, and to estimate the risk of adverse events due to sedative choice.MethodsThis is a secondary analysis of one health records review, the Recent Onset Atrial Fibrillation or Flutter-0 (RAFF-0 [n=420, 2008]) and one prospective cohort study, the Recent Onset Atrial Fibrillation or Flutter-1 (RAFF-1 [n=565, 2010 – 2012]) at eight and six Canadian EDs, respectively. Sedative choices within and among EDs were quantified, and the risk of adverse events was examined with adjusted and unadjusted comparisons of sedative regimes.ResultsIn RAFF-0 and RAFF-1, the combination of propofol and fentanyl was most popular (63.8% and 52.7%) followed by propofol alone (27.9% and 37.3%). There were substantially more adverse events in the RAFF-0 data set (13.5%) versus RAFF-1 (3.3%). In both data sets, the combination of propofol/fentanyl was not associated with increased adverse event risk compared to propofol alone.ConclusionThere is marked variability in procedural sedation medication choice for a direct current cardioversion in Canadian EDs, with increased use of propofol alone as a sedation agent over time. The risk of adverse events from procedural sedation during cardioversion is low but not insignificant. We did not identify an increased risk of adverse events with the addition of fentanyl as an adjunctive analgesic to propofol.
机译：目标尽管在急诊科（ED）中进行心脏复律的程序镇静是很常见的事件，但围绕药物选择的证据有限。我们试图评估加拿大多个地点的镇静剂选择的地理和时间变化，并评估由于镇静剂选择而引起的不良事件的风险。方法这是对一项健康记录进行了二次分析，即最近发生的房颤或Flutter-0（ RAFF-0 [n = 420，2008]）和一项前瞻性队列研究，分别是在加拿大的八名和六名ED中，最近发生的房颤或Flutter-1（RAFF-1 [n = 565，2010 – 2012]）。量化EDs内和EDs之间的镇静剂选择，并通过调整和未调整的镇静方案比较检查不良事件的风险。结果在RAFF-0和RAFF-1中，丙泊酚和芬太尼的组合最为流行（63.8％和52.7％） ），然后是单独的丙泊酚（27.9％和37.3％）。与RAFF-1（3.3％）相比，RAFF-0数据集中有更多的不良事件（13.5％）。在这两个数据集中，与单独使用丙泊酚相比，丙泊酚/芬太尼的组合与增加的不良事件风险无关。结论在加拿大急诊中，对于直接电复律的镇静药物选择存在明显差异，单独使用丙泊酚作为随时间使用镇静剂。在心脏复律过程中，从镇静过程中产生不良事件的风险较低，但并非微不足道。我们没有发现将芬太尼作为丙泊酚辅助镇痛剂添加而增加的不良事件风险。

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