the Major Joint Medical Research Project of Chongqing Science and Technology Commission and Chongqing Health Commission(2023DBXM003);the General Project of Technology Innovation and Application Development of Chongqing Science and Technology Bureau(CSTB2022TIAD-GPX0007)
Yifan CAO, Mengwei DING, Ling XIONG, et al. Risk factors for prolonged sedation recovery time in children with epilepsy[J]. Journal of Army Medical University, 2024, 46(14): 1653-1657.
DOI:
Yifan CAO, Mengwei DING, Ling XIONG, et al. Risk factors for prolonged sedation recovery time in children with epilepsy[J]. Journal of Army Medical University, 2024, 46(14): 1653-1657. DOI: 10.16016/j.2097-0927.202405042.
Risk factors for prolonged sedation recovery time in children with epilepsy
To analyze the risk factors for prolonged sedation recovery time in epileptic children.
Methods
2
A cross-sectional trial was conducted on the epileptic children who underwent electroencephalography (EEG) with oral administration of chloral hydrate and nasal dexmedetomidine for sedation in our hospital from November 2019 to December 2022. Their general information and sedation and medication data were collected. Prolonged sedation recovery time was defined as beyond the 75th percentile of awaking time
and then the children were divided into recovery time ≤1 h group and >1 h group. Univariate and multivariable logistic regression analyses were used to identify the risk factors for recovery time in these children.
Results
2
A total of 1 346 children were enrolled
including 805 males and 541 females
with a median age of 6.03 (4.42
8.56) years. There were 986 children assigned into recovery time ≤1 h group and 360 ones into recovery time
>
1 h group. Univariate analysis showed that significant differences were observed in the proportions of age
<
1 year (0.8%
vs
2.2%
P
=0.046)
sedation more than 3 times (35.8%
vs
42.2%
P
=0.031)
and treated with multiple antiepileptic drugs (AEDs) (25.5%
vs
36.9%
P
<
0.001) between the 2 groups. Multivariable logistic regression analysis indicated that age
<
1 year (
OR
=2.943
95%
CI
: 1.063~8.142
P
=0.034)
sedation times ≥3 (
OR
=1.287
95%
CI
: 1.003~1.649
P
=0.047) and multiple use of AEDs (
OR
=1.718
95%
CI
: 1.325~2.223
P
<
0.001) were risk factors for prolonged recovery time.
Conclusion
2
Age < 1 year
sedation times ≥3 and multiple use of AEDs are risk factors for prolonged sedation recovery time in epileptic children undergoing EEG after oral chloral hydrate and nasal dexmedetomidine.
关键词
Keywords
references
MASON K P, O'MAHONY E, ZURAKOWSKI D, et al . Effects of dexmedetomidine sedation on the EEG in children[J ] . Paediatr Anaesth, 2009, 19(12): 1175-1183. DOI: 10.1111/j.1460-9592.2009.03160.x.
FERNANDES M L, OLIVEIRA W M, SANTOS M D O C, et al . Sedation for electroencephalography with dexmedetomidine or chloral hydrate: a comparative stu dy on the qualitative and quantitative electroencephalogram pattern[J ] . J Neurosurg Anesthesiol, 2015, 27(1): 21-25. DOI: 10.1097/ANA.0000000000000077.
FALLAH R, ALAEI A, AKHAVAN KARBASI S, et al . Chloral hydrate, chloral hydrate: promethazine and chloral hydrate-hydroxyzine efficacy in electroencephalography sedation[J ] . Indian J Pediatr, 2014, 81(6): 541-546. DOI: 10.1007/s12098-013-1298-y.
KRAUSS B, GREEN S M. Procedural sedation and analgesia inchildren[J]. Lancet, 2006, 367(9512): 766-780. DOI: 10.1016/S0140-6736(06)68230-5.
BHATT M, KENNEDY R M, OSMOND M H, et al . Consensus-based recommendations for standardizing terminology and reporting adverse events for emergency department procedural sedation and analgesia in children[J ] . Ann Emerg Med, 2009, 53(4): 426-435. e4. DOI: 10.1016/j.annemergmed.2008.09.030.
KILBAUGH T J, FRIESS S H, RAGHUPATHI R, et al . Sedation and analgesia in children with developmental disabilities and neurologic disorders[J ] . Int J Pediatr, 2010, 2010: 189142. DOI: 10.1155/2010/189142.
PERUCCA E, BRODIE M J, KWAN P, et al . 30 years of second-generation antiseizure medications: impact and future perspectives[J ] . Lancet Neurol, 2020, 19(6): 544-556. DOI: 10.1016/S1474-4422(20)30035-1.
LIU X Y. Progress in diagnosis and treatment for pediatric intractableepilepsy[J]. J Third Mil Med Univ, 2012, 34(22): 2240-2243. DOI: 10.16016/j.1000-5404.2012.22.016.
China Association Against Epilepsy. Guidelines for clinical diagnosis and treatment-fascicle for epilepsy(revision 2023)[M]. Beijing: People's Health Publishing House, 2023: 40-48.
LUKAWSKI K, CZUCZWAR S J. Understanding mechanisms of drug resistance in epilepsy and strategies for overcomingit[J]. Expert Opin Drug Metab Toxicol, 2021, 17(9): 1075-1090. DOI: 10.1080/17425255.2021.1959912.
Neurology Society of Chinese Medical Association, Electroencephalography and Epilepsy Neurology of Chinese Medical Association. Chinese consensus for the antiseizure medications polytherapy[J]. Chin J Neurol, 2024, 57(2): 108-117. DOI: 10.3760/cma.j.cn113694-20230809-00039.
NAMAZI S, BORHANI-HAGHIGHI A, KARIMZADEH I. Adverse reactions to antiepileptic drugs in epileptic outpatients: a cross-sectional study in Iran[J]. Clin Neuropharmacol, 2011, 34(2): 79-83. DOI: 10.1097/WNF.0b013e318210ece0.
JOSHI R, TRIPATHI M, GUPTA P, et al . Adverse effects & drug load of antiepileptic drugs in patients with epilepsy: Monotherapy versus polytherapy[J ] . Indian J Med Res, 2017, 145(3): 317-326. DOI: 10.4103/ijmr.IJMR_710_15.
IHMSEN H, SAARI T I. Dexmedetomidine. pharmacokinetics and pharmacodynamics[J]. Anaesthesist, 2012, 61(12): 1059-1066. DOI: 10.1007/s00101-012-2114-1.
SPATZENEGGER M, JAEGER W. Clinical importance of hepatic cytochrome P450 in drug metabolism[J]. Drug Metab Rev, 1995, 27(3): 397-417. DOI: 10.3109/03602539508998329.
ZHOU X Q, ZHAO J L, TU H Y, et al . The effect of age on outpatient pediatric procedural sedation with intranasal dexmedetomidine and oral midazolam[J ] . Eur J Pediatr, 2024, 183(1): 169-177. DOI : 10.1007/s00431-023-05240-5.
TATEISHI T, NAKURA H, ASOH M, et al . A comparison of hepatic cytochrome P450 protein expression between infancy and postinfancy[J ] . Life Sci, 1997, 61(26): 2567-2574. DOI: 10.1016/s0024-3205(97)01011-4.
WANG J, LI Y, XIAO S N, et al . Efficacy and safety of intranasal dexmedetomidine versus oral chloral hydrate as sedatives for pediatric patients: a systematic review and meta-analysis[J ] . J Investig Med, 2022, 70(5): 1219-1224. DOI: 10.1136/jim-2021-002038.
Anesthesiology Branch of Chinese Medical Association. Chinese anesthesiology guide and expert consensus (2017)[M]. Beijing: People's Health Publishing House, 2017: 286-287.
CHEN H, YANG F, YE M, et al . Intranasal dexmedetomidine is an effective sedative agent for electroencephalography in children[J ] . BMC Anesthesiol, 2020, 20(1): 61. DOI: 10.1186/s12871-020-00978-z.