Jildenstål Pether K, Rawal Narinder, Hallén Jan L, Berggren Lars, Jakobsson Jan G
Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden.
Department of Anaesthesiology and Intensive Care, University Hospital, Örebro, Sweden ; CAMTÖ, Centre for Assessment of Medical Technology in Örebro, Sweden.
Ann Med Surg (Lond). 2014 Aug 12;3(3):100-7. doi: 10.1016/j.amsu.2014.07.001. eCollection 2014 Sep.
Cognitive side-effects such as emergence agitation (EA), postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are not infrequently complicating the postoperative care especially in elderly and fragile patients. The aim of the present survey was to gain insight regarding concern and interest in prevention and treatment strategies for postoperative delirium and dysfunction, and the use of EEG-based depth-of-anaesthesia monitoring possibly reducing the risk for cognitive side effects among anaesthesia personnel.
A web-based validated questionnaire was sent to all Swedish anaesthesiologists and nurse anaesthetists during summer 2013. The questionnaire consisted of 3 sections, subjective preferences, routines and practices related to the perioperative handling of EA, POD, POCD.
The response rate was 52%. Cardiovascular/pulmonary risks where assessed as importance by 98, 97% of responders while 69% considered the risk of neurocognitive side-effects important. When asked explicitly around cognitive side-effects 89%, 37% and 44% assessed awareness, POC and POD respectively of importance. EEG-based depth-of-anaesthesia monitors were used in 50% of hospitals. The responders were not convinced about the benefits of such monitors even in at-risk patients. Structured protocols for the management of postoperative cognitive side-effects were available only in few hospitals.
Swedish anaesthesia personnel are concerned about the risk of postoperative cognitive side-effects but are more concerned about cardiovascular/pulmonary risks, pain, PONV and the rare event of awareness. Most respondents were not convinced about the use of depth-of-anaesthesia monitors. There is a need to improve knowledge around risk factors, prevention and management of postoperative cognitive side effects.
认知副作用，如苏醒期躁动（EA）、术后谵妄（POD）和术后认知功能障碍（POCD），在术后护理中并不罕见，尤其是在老年和体弱患者中。本次调查的目的是深入了解对术后谵妄和功能障碍的预防和治疗策略的关注和兴趣，以及基于脑电图的麻醉深度监测的使用情况，这可能会降低麻醉人员中认知副作用的风险。
2013年夏季，向所有瑞典麻醉医生和麻醉护士发送了一份经过验证的网络问卷。问卷由3个部分组成，即与EA、POD、POCD围手术期处理相关的主观偏好、常规做法和实际操作。
回复率为52%。98%、97%的回复者认为心血管/肺部风险很重要，而69%的人认为神经认知副作用的风险很重要。当明确询问认知副作用时，分别有89%、37%和44% 的回复者认为知晓、POCD和POD很重要。50%的医院使用基于脑电图的麻醉深度监测仪。即使在高危患者中，回复者也不相信此类监测仪的益处。只有少数医院有术后认知副作用管理的结构化方案。
瑞典麻醉人员关注术后认知副作用的风险，但更关注心血管/肺部风险、疼痛、术后恶心呕吐和罕见的知晓事件。大多数受访者不相信使用麻醉深度监测仪。有必要提高对术后认知副作用的风险因素、预防和管理的认识。
