Effects of esketamine sedation compared to morphine analgesia on hydrostatic reduction of intussusception: A case‐cohort comparison study
Summary Background Hydrostatic or pneumatic reduction of intussusception is an invasive procedure that is stressful and may be painful for a child. Resistance of the child may increase the duration of the procedure and decrease success rate of reduction. Analgesia can help to reduce pain, but not ne...
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| Veröffentlicht in: | Pediatric anesthesia 2017-11, Vol.27 (11), p.1091-1097 |
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| creator | Bunt, Jascha A. Veldhoen, Esther S. Nievelstein, Rutger A. J. Hulsker, Caroline C. C. Schouten, Antonius N. J. Herwaarden, Maud Y. A. Veyckemans, Francis |
| description | Summary
Background
Hydrostatic or pneumatic reduction of intussusception is an invasive procedure that is stressful and may be painful for a child. Resistance of the child may increase the duration of the procedure and decrease success rate of reduction. Analgesia can help to reduce pain, but not necessarily resistance. General anesthesia increases success rate of reduction. However, it requires the presence of an anesthesiologist, and may lead to anesthesia‐related complications. Procedural sedation with esketamine could be a safe alternative.
Aim
The aim of this study was to compare hydrostatic reduction using morphine analgesia compared to procedural sedation with esketamine in terms of success rate, adverse events, and duration of reduction.
Methods
A retrospective case‐cohort comparison study was performed with two groups of patients who had undergone hydrostatic reduction for ileocolic intussusception and received morphine analgesia (n = 37) or esketamine sedation (n = 20). Until July 2013, reduction was performed after intravenously administered morphine. Hereafter, a new protocol for procedural sedation was implemented and reduction was performed after administration of esketamine. Cases were matched for age and duration of symptoms.
Results
No adverse events requiring intervention other than administration of oxygen were reported for either group. Success rate of reduction using esketamine sedation was 90% vs 70% using morphine analgesia, risk ratio (RR) 1.29, 95% CI[0.93‐1.77]. Recurrence rate using esketamine sedation was 10% vs 15% using morphine analgesia, RR 0.67, 95% CI[0.12‐3.57]. Reduction time was shorter using esketamine sedation (Median 5 minutes, IQR 9 minutes) vs morphine analgesia (Median 8 minutes, IQR 16 minutes, P = .04, Median difference 3, 95% CI[−1.50‐8.75]). Median hospital stay in the esketamine group was 1.5 days (IQR 1.8) vs 2 days (IQR 5.3) in the morphine group.
Conclusion
No serious adverse events were recorded. In comparison to morphine analgesia, with esketamine there was weak evidence for a higher success rate, lower recurrence rate, shorter duration, and shorter length of hospital stay. |
| doi_str_mv | 10.1111/pan.13226 |
| format | Article |
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Background
Hydrostatic or pneumatic reduction of intussusception is an invasive procedure that is stressful and may be painful for a child. Resistance of the child may increase the duration of the procedure and decrease success rate of reduction. Analgesia can help to reduce pain, but not necessarily resistance. General anesthesia increases success rate of reduction. However, it requires the presence of an anesthesiologist, and may lead to anesthesia‐related complications. Procedural sedation with esketamine could be a safe alternative.
Aim
The aim of this study was to compare hydrostatic reduction using morphine analgesia compared to procedural sedation with esketamine in terms of success rate, adverse events, and duration of reduction.
Methods
A retrospective case‐cohort comparison study was performed with two groups of patients who had undergone hydrostatic reduction for ileocolic intussusception and received morphine analgesia (n = 37) or esketamine sedation (n = 20). Until July 2013, reduction was performed after intravenously administered morphine. Hereafter, a new protocol for procedural sedation was implemented and reduction was performed after administration of esketamine. Cases were matched for age and duration of symptoms.
Results
No adverse events requiring intervention other than administration of oxygen were reported for either group. Success rate of reduction using esketamine sedation was 90% vs 70% using morphine analgesia, risk ratio (RR) 1.29, 95% CI[0.93‐1.77]. Recurrence rate using esketamine sedation was 10% vs 15% using morphine analgesia, RR 0.67, 95% CI[0.12‐3.57]. Reduction time was shorter using esketamine sedation (Median 5 minutes, IQR 9 minutes) vs morphine analgesia (Median 8 minutes, IQR 16 minutes, P = .04, Median difference 3, 95% CI[−1.50‐8.75]). Median hospital stay in the esketamine group was 1.5 days (IQR 1.8) vs 2 days (IQR 5.3) in the morphine group.
Conclusion
No serious adverse events were recorded. In comparison to morphine analgesia, with esketamine there was weak evidence for a higher success rate, lower recurrence rate, shorter duration, and shorter length of hospital stay.</description><identifier>ISSN: 1155-5645</identifier><identifier>EISSN: 1460-9592</identifier><identifier>DOI: 10.1111/pan.13226</identifier><identifier>PMID: 28940868</identifier><language>eng</language><publisher>France: Wiley Subscription Services, Inc</publisher><subject>analgesia ; Analgesia - methods ; Analgesics - therapeutic use ; Analgesics, Opioid - therapeutic use ; Anesthesia ; Case-Control Studies ; Child ; Child, Preschool ; conscious sedation ; dissociative anesthetics ; Female ; Humans ; Ileal Diseases - surgery ; Infant ; intussusception ; Intussusception - surgery ; ketamine ; Ketamine - therapeutic use ; Male ; Morphine - therapeutic use ; Retrospective Studies ; Success ; Treatment Outcome</subject><ispartof>Pediatric anesthesia, 2017-11, Vol.27 (11), p.1091-1097</ispartof><rights>2017 John Wiley & Sons Ltd</rights><rights>2017 John Wiley & Sons Ltd.</rights><rights>Copyright © 2017 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3796-1b7ca7c0616ee9f5518d6918a2b6f3c704d90a8d0741cbfbc0f7c21e3c2a70fa3</citedby><cites>FETCH-LOGICAL-c3796-1b7ca7c0616ee9f5518d6918a2b6f3c704d90a8d0741cbfbc0f7c21e3c2a70fa3</cites><orcidid>0000-0003-1555-3452</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fpan.13226$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fpan.13226$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28940868$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Veyckemans, Francis</contributor><creatorcontrib>Bunt, Jascha A.</creatorcontrib><creatorcontrib>Veldhoen, Esther S.</creatorcontrib><creatorcontrib>Nievelstein, Rutger A. J.</creatorcontrib><creatorcontrib>Hulsker, Caroline C. C.</creatorcontrib><creatorcontrib>Schouten, Antonius N. J.</creatorcontrib><creatorcontrib>Herwaarden, Maud Y. A.</creatorcontrib><creatorcontrib>Veyckemans, Francis</creatorcontrib><title>Effects of esketamine sedation compared to morphine analgesia on hydrostatic reduction of intussusception: A case‐cohort comparison study</title><title>Pediatric anesthesia</title><addtitle>Paediatr Anaesth</addtitle><description>Summary
Background
Hydrostatic or pneumatic reduction of intussusception is an invasive procedure that is stressful and may be painful for a child. Resistance of the child may increase the duration of the procedure and decrease success rate of reduction. Analgesia can help to reduce pain, but not necessarily resistance. General anesthesia increases success rate of reduction. However, it requires the presence of an anesthesiologist, and may lead to anesthesia‐related complications. Procedural sedation with esketamine could be a safe alternative.
Aim
The aim of this study was to compare hydrostatic reduction using morphine analgesia compared to procedural sedation with esketamine in terms of success rate, adverse events, and duration of reduction.
Methods
A retrospective case‐cohort comparison study was performed with two groups of patients who had undergone hydrostatic reduction for ileocolic intussusception and received morphine analgesia (n = 37) or esketamine sedation (n = 20). Until July 2013, reduction was performed after intravenously administered morphine. Hereafter, a new protocol for procedural sedation was implemented and reduction was performed after administration of esketamine. Cases were matched for age and duration of symptoms.
Results
No adverse events requiring intervention other than administration of oxygen were reported for either group. Success rate of reduction using esketamine sedation was 90% vs 70% using morphine analgesia, risk ratio (RR) 1.29, 95% CI[0.93‐1.77]. Recurrence rate using esketamine sedation was 10% vs 15% using morphine analgesia, RR 0.67, 95% CI[0.12‐3.57]. Reduction time was shorter using esketamine sedation (Median 5 minutes, IQR 9 minutes) vs morphine analgesia (Median 8 minutes, IQR 16 minutes, P = .04, Median difference 3, 95% CI[−1.50‐8.75]). Median hospital stay in the esketamine group was 1.5 days (IQR 1.8) vs 2 days (IQR 5.3) in the morphine group.
Conclusion
No serious adverse events were recorded. In comparison to morphine analgesia, with esketamine there was weak evidence for a higher success rate, lower recurrence rate, shorter duration, and shorter length of hospital stay.</description><subject>analgesia</subject><subject>Analgesia - methods</subject><subject>Analgesics - therapeutic use</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Anesthesia</subject><subject>Case-Control Studies</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>conscious sedation</subject><subject>dissociative anesthetics</subject><subject>Female</subject><subject>Humans</subject><subject>Ileal Diseases - surgery</subject><subject>Infant</subject><subject>intussusception</subject><subject>Intussusception - surgery</subject><subject>ketamine</subject><subject>Ketamine - therapeutic use</subject><subject>Male</subject><subject>Morphine - therapeutic use</subject><subject>Retrospective Studies</subject><subject>Success</subject><subject>Treatment Outcome</subject><issn>1155-5645</issn><issn>1460-9592</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10b1u1TAYBmALgWgpHbiByhJLGdLajn8StqOq_EgVMNA5cpzPnLRJHPw5qs7WnYVr5Erq03NgQGoWR_bjV7ZfQt5wdsbzdz7b6YyXQuhn5JBLzYpa1eJ5_udKFUpLdUBeId4wlpEWL8mBqGrJKl0dkl-X3oNLSIOngLeQ7NhPQBE6m_owURfG2UboaAp0DHFeb1ftZIcfgL2lWaw3XQyYMnc0w8U97stx_ZQWxAUdzNup93RFnUX4c__bhXWIaZ_dY-aYlm7zmrzwdkA43o9H5PrD5feLT8XV14-fL1ZXhStNrQveGmeNY5prgNorxatO17yyotW-dIbJrma26piR3LW-dcwbJziUTljDvC2PyOkud47h5wKYmrHPpxwGO0FYsOG1FEYyKWWmb_-jN2GJ-fpbpZgyQkmR1budcvklMIJv5tiPNm4azpptQ01uqHlsKNuTfeLSjtD9k38ryeB8B-76ATZPJzXfVl92kQ9SUJ5V</recordid><startdate>201711</startdate><enddate>201711</enddate><creator>Bunt, Jascha A.</creator><creator>Veldhoen, Esther S.</creator><creator>Nievelstein, Rutger A. J.</creator><creator>Hulsker, Caroline C. C.</creator><creator>Schouten, Antonius N. J.</creator><creator>Herwaarden, Maud Y. A.</creator><creator>Veyckemans, Francis</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1555-3452</orcidid></search><sort><creationdate>201711</creationdate><title>Effects of esketamine sedation compared to morphine analgesia on hydrostatic reduction of intussusception: A case‐cohort comparison study</title><author>Bunt, Jascha A. ; Veldhoen, Esther S. ; Nievelstein, Rutger A. J. ; Hulsker, Caroline C. C. ; Schouten, Antonius N. J. ; Herwaarden, Maud Y. A. ; Veyckemans, Francis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3796-1b7ca7c0616ee9f5518d6918a2b6f3c704d90a8d0741cbfbc0f7c21e3c2a70fa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>analgesia</topic><topic>Analgesia - methods</topic><topic>Analgesics - therapeutic use</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Anesthesia</topic><topic>Case-Control Studies</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>conscious sedation</topic><topic>dissociative anesthetics</topic><topic>Female</topic><topic>Humans</topic><topic>Ileal Diseases - surgery</topic><topic>Infant</topic><topic>intussusception</topic><topic>Intussusception - surgery</topic><topic>ketamine</topic><topic>Ketamine - therapeutic use</topic><topic>Male</topic><topic>Morphine - therapeutic use</topic><topic>Retrospective Studies</topic><topic>Success</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bunt, Jascha A.</creatorcontrib><creatorcontrib>Veldhoen, Esther S.</creatorcontrib><creatorcontrib>Nievelstein, Rutger A. J.</creatorcontrib><creatorcontrib>Hulsker, Caroline C. C.</creatorcontrib><creatorcontrib>Schouten, Antonius N. J.</creatorcontrib><creatorcontrib>Herwaarden, Maud Y. A.</creatorcontrib><creatorcontrib>Veyckemans, Francis</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bunt, Jascha A.</au><au>Veldhoen, Esther S.</au><au>Nievelstein, Rutger A. J.</au><au>Hulsker, Caroline C. C.</au><au>Schouten, Antonius N. J.</au><au>Herwaarden, Maud Y. A.</au><au>Veyckemans, Francis</au><au>Veyckemans, Francis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effects of esketamine sedation compared to morphine analgesia on hydrostatic reduction of intussusception: A case‐cohort comparison study</atitle><jtitle>Pediatric anesthesia</jtitle><addtitle>Paediatr Anaesth</addtitle><date>2017-11</date><risdate>2017</risdate><volume>27</volume><issue>11</issue><spage>1091</spage><epage>1097</epage><pages>1091-1097</pages><issn>1155-5645</issn><eissn>1460-9592</eissn><abstract>Summary
Background
Hydrostatic or pneumatic reduction of intussusception is an invasive procedure that is stressful and may be painful for a child. Resistance of the child may increase the duration of the procedure and decrease success rate of reduction. Analgesia can help to reduce pain, but not necessarily resistance. General anesthesia increases success rate of reduction. However, it requires the presence of an anesthesiologist, and may lead to anesthesia‐related complications. Procedural sedation with esketamine could be a safe alternative.
Aim
The aim of this study was to compare hydrostatic reduction using morphine analgesia compared to procedural sedation with esketamine in terms of success rate, adverse events, and duration of reduction.
Methods
A retrospective case‐cohort comparison study was performed with two groups of patients who had undergone hydrostatic reduction for ileocolic intussusception and received morphine analgesia (n = 37) or esketamine sedation (n = 20). Until July 2013, reduction was performed after intravenously administered morphine. Hereafter, a new protocol for procedural sedation was implemented and reduction was performed after administration of esketamine. Cases were matched for age and duration of symptoms.
Results
No adverse events requiring intervention other than administration of oxygen were reported for either group. Success rate of reduction using esketamine sedation was 90% vs 70% using morphine analgesia, risk ratio (RR) 1.29, 95% CI[0.93‐1.77]. Recurrence rate using esketamine sedation was 10% vs 15% using morphine analgesia, RR 0.67, 95% CI[0.12‐3.57]. Reduction time was shorter using esketamine sedation (Median 5 minutes, IQR 9 minutes) vs morphine analgesia (Median 8 minutes, IQR 16 minutes, P = .04, Median difference 3, 95% CI[−1.50‐8.75]). Median hospital stay in the esketamine group was 1.5 days (IQR 1.8) vs 2 days (IQR 5.3) in the morphine group.
Conclusion
No serious adverse events were recorded. In comparison to morphine analgesia, with esketamine there was weak evidence for a higher success rate, lower recurrence rate, shorter duration, and shorter length of hospital stay.</abstract><cop>France</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28940868</pmid><doi>10.1111/pan.13226</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-1555-3452</orcidid></addata></record> |
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| ispartof | Pediatric anesthesia, 2017-11, Vol.27 (11), p.1091-1097 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | analgesia Analgesia - methods Analgesics - therapeutic use Analgesics, Opioid - therapeutic use Anesthesia Case-Control Studies Child Child, Preschool conscious sedation dissociative anesthetics Female Humans Ileal Diseases - surgery Infant intussusception Intussusception - surgery ketamine Ketamine - therapeutic use Male Morphine - therapeutic use Retrospective Studies Success Treatment Outcome |
| title | Effects of esketamine sedation compared to morphine analgesia on hydrostatic reduction of intussusception: A case‐cohort comparison study |
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