A202 EFFECT OF A SINGLE DOSE OF LORAZEPAM ON SALIVARY CORTISOL RESPONSE IN CHILDREN UNDERGOING DIGESTIVE ENDOSCOPY: A RANDOMIZED DOUBLE BLINDED STUDY
Notice bibliographique
Résumé
Children undergoing digestive endoscopies express a high level of procedural anxiety. We have shown that salivary Cortisol (sCortisol) is a reliable biomarker of stress in children undergoing endoscopy. It was recently suggested that preoperative psychological status can impact procedural comfort. This randomized trial was designed to investigate the impact of an oral benzodiazepine on the levels of sCortisol and pain score during digestive endoscopies under intravenous sedation. The primary aim was to assess the effect of Lorazepam as compared to placebo on the changes of sCortisol between baseline (C1) and one hour after administration (C2). The secondary aims were to assess the percentage of children experiencing procedural pain and procedure duration. Subjects were prospectively randomized in one of the following groups: Group A (oral Lorazepam, 0.5 mg (body weight < 40 kg) or 1 mg (body weight > 40 kg); Group B (placebo). Randomization was done by blocks of 6 and stratification was performed on sex and previous endoscopy experience. Before the procedure, 2 saliva samples (C1 and C2) were taken with cortisol Salivette tubes. A visual anxiety scale (VAS) and the State Trait Anxiety Inventory for Children (STAIC) were completed at baseline. Sedation protocol was done with intravenous administration of Fentanyl and Midazolam +/- Ketamine. Pain assessment was performed by recording the Nurse-Assessed Patient Comfort Score (NAPCOMS) during each procedure. Ninety children were included in the study. In this interim analysis of 44 children (22 females), sCortisol baseline mean (SD) was 75.3 ± 32.4 nmol/L in Group A and 66.7 ± 34.6 nmol/L in Group B (p=0.47). For children having a colonoscopy, there was a decrease in sCortisol in the Lorazepam arm whereas it increased in the placebo arm. The mean (min-max) change in sCortisol between C1 and C2 was -4.8 (-43.8; + 94.5) nmol/L in Group A and +31.4 nmol/L (-35.2; +267.5) in Group B. For the NAPCOMS, the median (IQR) was lower in Group A than in Group B: [2 (0.0 – 5.0) and 5.0 (2.5 – 6.0) respectively (p=0.185)]. In Group B, 27% of children felt pain (NAPCOMS ≥ 6) compared to 18.2 % in Group A (p=0.47). For children undergoing colonoscopy, 37.5 % felt pain in the placebo arm as compared to 20 % in the Lorazepam arm (absolute difference of 17.5%). No difference was found between groups for adverse events rate. Oral Lorazepam was associated with a decrease of sCortisol and a lower pain score in patients having a colonoscopy. This pilot study had a decent inclusion rate (61% of eligible participants). A large randomized trial assessing the impact of Lorazepam on pain score in children before colonoscopy is therefore feasible. FRQS
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,006 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».