Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School and Hospital, 671 Jebongro Dong-gu, Gwangju 501-757, Republic of Korea.
Br J Anaesth. 2011 Dec;107(6):930-3. doi: 10.1093/bja/aer275. Epub 2011 Sep 7.
Paradoxical excitement response during sedation consists of loss of affective control and abnormal movements. Chronic alcohol abuse has been proposed as a predisposing factor despite lack of supporting evidence. Because alcohol and propofol have a common site of action, we postulated that paradoxical excitement responses during propofol-induced sedation occur more frequently in hazardous and harmful alcohol drinkers than in social or non-drinkers.
One hundred and ninety patients undergoing orthopaedic knee joint surgery were enrolled in this prospective and observational study. Subjects were divided into Group HD (hazardous and harmful drinkers) or Group NHD (no hazardous drinkers) according to the alcohol use disorder identification test (AUDIT). In study 1, propofol infusion was adjusted to achieve the bispectral index at 70-80 using target-controlled infusion. In study 2, the target concentration of propofol was fixed at 0.8 (study 2/Low) or 1.4 μg ml(-1) (study 2/High). Paradoxical excitement responses were categorized by intensity into mild, moderate, or severe.
The overall incidence of paradoxical excitement response was higher in Group HD than in Group NHD in study 1 (71.4% vs 43.8%; P=0.022) and study 2/High (70.0% vs 34.5%; P=0.006) but not in study 2/Low. The incidence of moderate-to-severe response was significantly higher in Group HD of study 1 (28.6% vs 3.1%; P=0.0005) and study 2/High (23.3% vs 3.4%; P=0.029) with no difference in study 2/Low. Severe excitement response occurred only in Group HD of study 1 and study 2/High.
Paradoxical excitement occurred more frequently and severely in hazardous and harmful alcohol drinkers than in social drinkers during propofol-induced moderate-to-deep sedation, but not during light sedation.
镇静状态下的矛盾兴奋反应表现为情感控制丧失和异常运动。尽管缺乏支持性证据，但慢性酒精滥用被认为是一个易患因素。由于酒精和丙泊酚的作用部位相同，我们推测丙泊酚诱导镇静期间的矛盾兴奋反应在高危和有害饮酒者中比在社交或非饮酒者中更频繁发生。
本前瞻性观察研究纳入了 190 名接受矫形膝关节手术的患者。根据酒精使用障碍识别测试（AUDIT），将受试者分为 HD 组（高危和有害饮酒者）或 NHD 组（无高危饮酒者）。在研究 1 中，使用靶控输注将丙泊酚输注量调整至双谱指数 70-80。在研究 2 中，将丙泊酚的目标浓度固定在 0.8（研究 2/低）或 1.4μg/ml（研究 2/高）。矛盾兴奋反应的强度分为轻度、中度或重度。
在研究 1（71.4%比 43.8%；P=0.022）和研究 2/高（70.0%比 34.5%；P=0.006）中，HD 组的矛盾兴奋反应总发生率高于 NHD 组，但在研究 2/低中则没有。在研究 1（28.6%比 3.1%；P=0.0005）和研究 2/高（23.3%比 3.4%；P=0.029）中，HD 组中度至重度反应的发生率显著高于 NHD 组，但在研究 2/低中则没有差异。严重兴奋反应仅发生在研究 1 的 HD 组和研究 2/高组。
在丙泊酚诱导的中至深度镇静期间，高危和有害饮酒者比社交饮酒者更频繁且更严重地发生矛盾兴奋反应，但在轻度镇静期间则没有差异。
