择期行腰椎手术的老年和青年患者中七氟醚-瑞芬太尼麻醉时血浆食欲素-A 水平的变化。

Changes in plasma orexin-A levels in sevoflurane-remifentanil anesthesia in young and elderly patients undergoing elective lumbar surgery.

机构信息

From the Department of Anesthesiology, Xijing Hospital, Fourth Military Medical University, Shaanxi, China.

出版信息

Anesth Analg. 2014 Apr;118(4):818-22. doi: 10.1213/ANE.0000000000000109.

DOI:10.1213/ANE.0000000000000109

PMID:24651236

Abstract

BACKGROUND

Delayed emergence from general anesthesia frequently occurs in elderly patients, but the reason is not clear. Orexin has been shown to be involved in arousal from general anesthesia. In this study, we examined plasma orexin-A levels in both elderly and young patients during the anesthesia arousal cycle.

METHODS

We recruited 41 patients scheduled for elective lumbar surgery and eventually evaluated 34 patients. Patients were divided into a young group (age 30-55, N = 16) and an elderly group (age 65-77, N = 18). Anesthesia with sevoflurane-remifentanil was titrated to maintain the Bispectral Index between 45 and 65. The times from stopping anesthesia to eyes opening and extubation were recorded. Arterial blood was collected, and plasma orexin-A was determined by radioimmunoassay at the following 4 time points: preanesthesia (T0), 1 hour after anesthesia induction (T1), emergence (5 minutes after tracheal extubation) (T2), and 30 minutes after tracheal extubation (T3).

RESULTS

The times from stopping anesthesia to eyes opening and tracheal extubation were both significantly longer in the elderly group than in the young group (P = 0.004, P = 0.01, respectively). Basal (T0) orexin-A levels were higher in the elderly group than in the young group (T0, 26.13 ± 1.25 vs 17.9 ± 1.30 pg/mL, P < 0.0001). Plasma orexin-A levels did not change during induction of anesthesia in either group but significantly increased at T2 (vs T0, P <0.0001) in both elderly (35.0 ± 1.7 pg/mL) and young (29.2 ± 1.9 pg/mL) groups. Orexin-A levels were significantly higher in the elderly than in the young group at T1, T2, and T3.

CONCLUSION

Plasma orexin-A levels are not responsible for the delayed emergence from general anesthesia in elderly patients.

摘要

背景

全麻苏醒延迟在老年患者中较为常见，但原因尚不清楚。orexin 已被证明与全麻苏醒有关。在这项研究中，我们检测了麻醉苏醒周期中老年和年轻患者的血浆 orexin-A 水平。

方法

我们招募了 41 名拟行择期腰椎手术的患者，最终评估了 34 名患者。患者分为年轻组（年龄 30-55 岁，N = 16）和老年组（年龄 65-77 岁，N = 18）。七氟醚-瑞芬太尼麻醉，根据脑电双频指数（Bispectral Index）调整麻醉深度，维持在 45-65 之间。记录从停止麻醉到睁眼和拔管的时间。在以下 4 个时间点采集动脉血，用放射免疫法测定血浆 orexin-A：麻醉前（T0）、麻醉诱导后 1 小时（T1）、苏醒时（气管拔管后 5 分钟）（T2）、气管拔管后 30 分钟（T3）。

结果

老年组从停止麻醉到睁眼和拔管的时间均明显长于年轻组（P = 0.004，P = 0.01）。老年组基础（T0）orexin-A 水平高于年轻组（T0，26.13 ± 1.25 比 17.9 ± 1.30 pg/mL，P < 0.0001）。两组麻醉诱导期间血浆 orexin-A 水平均无变化，但两组在 T2 时均明显升高（与 T0 相比，P < 0.0001），老年组为 35.0 ± 1.7 pg/mL，年轻组为 29.2 ± 1.9 pg/mL。T1、T2 和 T3 时老年组 orexin-A 水平明显高于年轻组。