Przybylo H J, Martini D R, Mazurek A J, Bracey E, Johnsen L, Coté C J
Department of Pediatric Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60614, USA.
Paediatr Anaesth. 2003 Sep;13(7):609-16. doi: 10.1046/j.1460-9592.2003.01099.x.
No standardized instrument exists for the systematic analysis of emergence behaviour in children after anaesthesia. Our purpose was to evaluate children's behaviour prior to anaesthetic induction and immediately upon emergence to develop an assessment tool using psychiatric terminology and techniques.
This prospective study evaluated 25 children from 2 to 9 years of age for preanaesthetic psychosocial factors that might affect behaviour. Children's behaviour was observed from admission to the surgical unit through the induction of anaesthesia. All children received a standardized premedication and induction of anaesthesia. The maintenance anaesthetic was randomized to intravenous remifentanil or inhaled isoflurane. All children underwent repair of strabismus. We assessed the behaviour of children for 30 min upon emergence from anaesthesia for symptoms of pain, distress and delirium using an assessment tool we developed guided by the principles of psychiatry as described in Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
Using our assessment tool, 44% of children demonstrated altered behaviour on emergence; 20% demonstrated complex symptoms with characteristics of delirium. Children anaesthetized with isoflurane had significantly higher postanaesthesia behaviour assessment scores than those anaesthetized with remifentanil (P = 0.04). Age was a significant variable; children <62 months were more prone to altered behaviour than those >62 months (P = 0.02). Scores did not correlate with preanaesthetic risk factors including preexisting psychological or social variables or observed preanaesthetic distress. There was no delay in hospital discharge in children assessed as having altered behaviour.
This exploratory study suggests that postanaesthetic behaviour abnormalities with characteristics of distress or delirium can be categorized using known DSM-IV terminology; in our cohort this behaviour was dependent on age and anaesthetic technique.
目前尚无用于系统分析儿童麻醉后苏醒行为的标准化工具。我们的目的是评估儿童麻醉诱导前及苏醒即刻的行为，以利用精神病学术语和技术开发一种评估工具。
这项前瞻性研究评估了25名2至9岁儿童，以确定可能影响行为的麻醉前心理社会因素。从儿童进入手术科室到麻醉诱导期间观察其行为。所有儿童均接受标准化的术前用药和麻醉诱导。维持麻醉随机采用静脉注射瑞芬太尼或吸入异氟烷。所有儿童均接受斜视矫正手术。我们使用一种根据《精神疾病诊断与统计手册》（DSM-IV）中所述的精神病学原则开发的评估工具，在儿童麻醉苏醒后30分钟内评估其疼痛、痛苦和谵妄症状的行为。
使用我们的评估工具，44%的儿童在苏醒时表现出行为改变；20%表现出具有谵妄特征的复杂症状。接受异氟烷麻醉的儿童术后行为评估得分显著高于接受瑞芬太尼麻醉的儿童（P = 0.04）。年龄是一个显著变量；62个月以下的儿童比62个月以上的儿童更容易出现行为改变（P = 0.02）。得分与麻醉前危险因素无关，包括既往心理或社会变量或观察到的麻醉前痛苦。被评估为行为改变的儿童出院没有延迟。
这项探索性研究表明，具有痛苦或谵妄特征的麻醉后行为异常可以使用已知的DSM-IV术语进行分类；在我们的队列中，这种行为取决于年龄和麻醉技术。
