Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore.
Anaesthesia. 2015 Apr;70(4):393-9. doi: 10.1111/anae.12867. Epub 2014 Oct 14.
Emergence delirium is a significant problem in children regaining consciousness following general anaesthesia. We compared the emergence characteristics of 120 patients randomly assigned to receive a single intravenous dose of dexmedetomidine 0.3 μg.kg(-1) , propofol 1 mg.kg(-1) , or 10 ml saline 0.9% before emerging from general anaesthesia following a magnetic resonance imaging scan. Emergence delirium was diagnosed as a score of 10 or more on the Paediatric Anaesthesia Emergence Delirium scale. The incidence of emergence delirium was 42.5% in the dexmedetomidine group, 33.3% in the propofol group and 41.5% in the saline group (p = 0.671). Three patients in the dexmedetomidine group, none in the propofol group and two in the saline group required pharmacological intervention for emergence delirium (p = 0.202). Administration of neither dexmedetomidine nor propofol significantly reduced the incidence, or severity, of emergence delirium. The only significant predictor for emergence delirium was the time taken to awaken from general anaesthesia, with every minute increase in wake-up time reducing the odds of emergence delirium by 7%.
麻醉苏醒期谵妄是全麻后儿童意识恢复时的一个重大问题。我们比较了 120 例患者的苏醒特征，这些患者在接受磁共振成像扫描后随机分为三组，分别静脉给予右美托咪定 0.3μg.kg-1、丙泊酚 1mg.kg-1 或生理盐水 10ml 0.9%。麻醉苏醒期谵妄根据小儿麻醉苏醒期谵妄量表评分 10 分或以上进行诊断。右美托咪定组、丙泊酚组和生理盐水组的麻醉苏醒期谵妄发生率分别为 42.5%、33.3%和 41.5%（p=0.671）。右美托咪定组有 3 例患者、丙泊酚组无一例患者和生理盐水组有 2 例患者需要药物干预治疗苏醒期谵妄（p=0.202）。右美托咪定和丙泊酚的使用均不能显著降低苏醒期谵妄的发生率或严重程度。唯一显著的苏醒期谵妄预测因子是从全麻中苏醒的时间，苏醒时间每增加 1 分钟，苏醒期谵妄的几率就降低 7%。
