Malviya Shobha, Voepel-Lewis Terri, Ludomirsky Achiau, Marshall Janelle, Tait Alan R
Department of Anesthesiology, C.S. Mott Children's Hospital, University of Michigan Health Systems, F3900, Box 0211, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0211, USA.
Anesthesiology. 2004 Feb;100(2):218-24. doi: 10.1097/00000542-200402000-00007.
Current recommended discharge criteria might not be rigorous enough to detect residual sedation. This study evaluated the use of the Bispectral Index (BIS monitor), the University of Michigan Sedation Scale (UMSS; i.e., 0-4 observational scale), and a Modified Maintenance of Wakefulness Test (MMWT; visual observation of the time the child is able to stay awake) in assessing return to baseline status.
Twenty-nine children sedated for echocardiographic examination were studied. Nurses administered sedatives and monitored and discharged children according to institutional guidelines. Children were monitored with the BIS(R) throughout the study. Trained observers assigned UMSS scores every 10-15 min until revised discharge criteria were met (i.e., UMSS score of 0 or 1, MMWT duration >/= 20 min). The MMWT value was recorded at each observation following the procedure. Subsequently, blinded observers recorded average BIS values for the 5 min before each UMSS observation.
There were moderate correlations between the BIS, MMWT, and UMSS scores (r = 0.68-0.78; P < 0.01). Revised criteria correctly identified children who were awake and alert (BIS value >/= 90) in 88% of the cases. Only 55% of the children had returned to baseline BIS values when discharged by the nurse, compared with 92% when revised criteria were met (P < 0.05). It took longer to meet revised criteria compared with standard criteria (75.3 +/- 76.2 min vs. 16.4 +/- 13.1 min; P = 0.001).
The incorporation of specific, objective discharge criteria (i.e., UMSS score of 0 or 1, MMWT duration >/= 20 min) may ensure a status closer to baseline (BIS value >/= 90) compared with nursing judgment using standard criteria. However, such assurance may delay the discharge of sedated children.
当前推荐的出院标准可能不够严格，无法检测出残留的镇静作用。本研究评估了使用脑电双频指数（BIS监测仪）、密歇根大学镇静量表（UMSS；即0 - 4级观察量表）和改良清醒维持测试（MMWT；通过视觉观察儿童能够保持清醒的时间）来评估是否恢复到基线状态。
对29名因超声心动图检查而接受镇静的儿童进行了研究。护士根据机构指南给予镇静剂，并对儿童进行监测和办理出院手续。在整个研究过程中，使用BIS对儿童进行监测。经过培训的观察员每10 - 15分钟记录一次UMSS评分，直到符合修订后的出院标准（即UMSS评分为0或1，MMWT持续时间≥20分钟）。在操作后的每次观察时记录MMWT值。随后，不知情的观察员记录每次UMSS观察前5分钟的平均BIS值。
BIS、MMWT和UMSS评分之间存在中等程度的相关性（r = 0.68 - 0.78；P < 0.01）。修订后的标准在88%的病例中正确识别出清醒且警觉的儿童（BIS值≥90）。护士办理出院手续时，只有55%的儿童恢复到了基线BIS值，而符合修订标准时这一比例为92%（P < 0.05）。与标准标准相比，达到修订标准所需的时间更长（75.3 ± 76.2分钟对16.4 ± 13.1分钟；P = 0.001）。
与使用标准标准的护理判断相比，纳入特定的、客观的出院标准（即UMSS评分为0或1，MMWT持续时间≥20分钟）可能确保更接近基线状态（BIS值≥90）。然而，这种保证可能会延迟镇静儿童的出院。
