Department of Anesthesiology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
J Clin Anesth. 2009 Dec;21(8):567-73. doi: 10.1016/j.jclinane.2009.01.011.
To identify risk factors for reversible psychomotor dysfunction after prolonged sedation with isoflurane during mechanical ventilation in the intensive care unit (ICU).
Retrospective case series.
General ICU at Tonami General Hospital.
The records of 335 patients, aged from 10 months to 93 years, who were sedated with isoflurane for more than 12 hours, were reviewed. The presence or absence of reversible psychomotor dysfunction after weaning from mechanical ventilation during isoflurane sedation, and its type and duration, if present, were recorded. Data on patients' demographics, duration of isoflurane inhalation, minimum alveolar concentration (MAC)-hours of isoflurane, and concomitant medical treatments were recorded.
Twelve patients (3.6%) developed reversible psychomotor dysfunction, including systemic or localized tremor, chorea, and hallucination, which lasted 10 minutes to 6 days after weaning from mechanical ventilation during isoflurane sedation. Such psychomotor dysfunction occurred in 42% (8 of 19) of patients aged 4 years or less, while only in 1.3% (4 of 316) of those older than 4 years (P < 0.0001). It occurred in 0% (none of 167) of patients receiving isoflurane for 24 hours or less, while in 7.1% (12 of 168) of patients receiving it for more than 24 hours (P = 0.0004). Other factors examined, including gender, MAC-hours, and drugs co-administrated with isoflurane, did not affect its incidence.
Four years of age or less and isoflurane inhalation for more than 24 hours were considered to be significant risk factors for the development of reversible psychomotor dysfunction after prolonged sedation with isoflurane.
确定在重症监护病房（ICU）中使用异氟醚进行机械通气长时间镇静后发生可逆性精神运动功能障碍的危险因素。
回顾性病例系列研究。
富山综合医院普通 ICU。
对 335 名年龄在 10 个月至 93 岁之间、使用异氟醚镇静超过 12 小时的患者的记录进行了回顾。记录了在异氟醚镇静期间从机械通气中脱机后是否存在可逆性精神运动功能障碍，如果存在，其类型和持续时间。记录了患者的人口统计学数据、异氟醚吸入时间、异氟醚最低肺泡浓度（MAC）-小时数和同时进行的医疗治疗。
12 名患者（3.6%）出现可逆性精神运动功能障碍，包括全身性或局部性震颤、舞蹈病和幻觉，这些症状在异氟醚镇静期间从机械通气中脱机后持续 10 分钟至 6 天。这种精神运动功能障碍发生在 4 岁或以下的患者中占 42%（19 名患者中的 8 名），而在 4 岁以上的患者中仅占 1.3%（316 名患者中的 4 名）（P < 0.0001）。在接受异氟醚治疗 24 小时或更短时间的患者中，没有患者出现这种情况（167 名患者中没有 1 名），而在接受异氟醚治疗超过 24 小时的患者中，有 7.1%（168 名患者中的 12 名）出现这种情况（P = 0.0004）。其他检查的因素，包括性别、MAC-hours 和与异氟醚同时使用的药物，并没有影响其发病率。
4 岁或以下以及异氟醚吸入超过 24 小时被认为是在长时间使用异氟醚镇静后发生可逆性精神运动功能障碍的重要危险因素。
