Title: Ouchless Options for Pediatric Procedural Sedation
题目：儿童操作镇静的优势选择
Author 作者: Joey Scollan

Nitrous Oxide: Provides anxiolysis, mild analgesia and sedation
一氧化二氮（笑气）可有抗焦虑，温和的镇痛和镇静作用
Pros 优点-
Efficacious
效果好
Quick on and off , no lingering effects once gas is removed
起效和作用消失快，一旦气体被排除就没有遗留的影响
Self-titrating when patient holds their own mask
当患者自己拿着面罩时，可做自我调整
Large safety profile
安全性能好
No fasting necessary
不需要空腹
Cons 缺点-
MUST know contraindications:
必须掌握的禁忌症：
Any patient with an air filled cavity (pneumothorax, pulmonary bleb, bowel obstruction, intracranial process, etc) because nitrous has the ability to diffuse from the bloodstream into these cavities and cause them to expand
任何有空气存在空洞的病人（如气胸，肺大疱，肠梗阻，颅内病变等），因为笑气能从血液中扩散到这些空腔，使他们扩大
Pregnancy, since nitrous is known to be teratogenic
妊娠，因为笑气有致畸作用
Side Effects 副作用-
Nausea and vomiting are by far the most common
迄今为止恶心和呕吐是最常见的
An insignificant amount of hypoxia
轻度缺氧

Intranasal Options 鼻腔内用药选择:
Midazolam 咪达唑仑
Dosing- 0.2-0.5 mg/kg
剂量0.2-0.5毫克/公斤
Onset: Almost immediate
起效时间：几乎是立刻
Duration:  30-45 minutes
作用时间：30-45分钟
Fentanyl 芬太尼
Dosing- 1.5 to 3 mcg/kg
剂量1.5〜3微克/公斤体重
Onset:  almost immediate
起效时间：几乎是立竿见影
Duration: 45 minutes – 1 hour
作用时间：45分钟 - 1小时
Dexmedetomidine 右美托咪定
Often used by anesthesiologists as premedication for deeper sedation, not yet appearing in EM literature
经常被麻醉医师用来做深度镇静前用药，尚未有急诊文献报到
Ketamine 氯胺酮
Limited published data on appropriate dosing and safety profile, but strong potential for future use
对适当的剂量和安全性的资料报告很有限，但将来使用的潜力会很大

References参考文献：
Lane RE, Schunk JD. Atomized intranasal midazolam use for minor procedures in thepediatric emergency department. Pediatr Emerg Care. 2008 May;24(5):300-3. doi: 10.1097/PEC.0b013e31816ecb6f.
National Institute for Health and Clinical Excellence (NICE). Sedation in children and young people. Sedation for diagnostic and therapeutic procedures in children and young people. London (UK): National Institute for Health and Clinical Excellence (NICE); 2010 Dec. 30 p. (Clinical guideline; no. 112).
 Zier JL, Liu M. Safety of High-Concentration Nitrous Oxide by Nasal Mask for Pediatric Procedural Sedation. Pediatr Emerg Care 2011; 27: 1107-1112.