Somaini Marta, Sahillioğlu Emre, Marzorati Chiara, Lovisari Federica, Engelhardt Thomas, Ingelmo Pablo M
Department of Anaesthesia and Intensive Care, Niguarda Ca' Granda Hospital, Milan-Bicocca University, Milan, Italy.
Paediatr Anaesth. 2015 May;25(5):524-9. doi: 10.1111/pan.12580. Epub 2015 Jan 8.
Children commonly display early postoperative negative behavior (e-PONB) after general anesthesia, which includes emergence delirium (ED), discomfort, temperament, and pain. However, it is often difficult for the caregiver to discriminate between various aspects of e-PONB.
This prospective observational study evaluates the possibility to distinguish between ED and pain in young children using validated pediatric observational scales in the early postoperative phase.
Following institutional approval and written consent, children undergoing elective adenoidectomy and/or tonsillectomy were enrolled. Following standardized anesthesia, two trained observers simultaneously evaluated children's behavior with the Paediatric Anaesthesia Emergence Delirium Scale (PAED) and with the Face, Legs, Activity, Cry, Consolability scale (FLACC) at extubation, and at 5, 10, and 15 min.
Of 150 children that completed the study, 32 (21%) had ED, 7 (5%) had pain, and 98 (65%) had simultaneously both ED and pain. The association of 'No eye contact', 'No purposeful action' and 'No awareness of surroundings' (ED1) had a sensitivity of 0.96 and a specificity of 0.80 (PPV 0.97, NPV 0.78) to identify ED. 'Inconsolability' and 'Restlessness' (ED2) had a sensitivity of 0.69 and a specificity of 0.88 (PPV 0.83 and NPV 0.78) to identify pain.
It is difficult to differentiate between ED and pain using FLACC and PAED scores. 'No eye contact', 'No purposeful action', and 'No awareness of surroundings' significantly correlated with ED. 'Inconsolability' and 'Restlessness' are not reliable enough to identify pain or ED in the first 15 min after awakening.
儿童在全身麻醉后通常会出现早期术后负面行为（e-PONB），包括苏醒期谵妄（ED）、不适、性情改变和疼痛。然而，护理人员往往难以区分e-PONB的各个方面。
这项前瞻性观察性研究评估了在术后早期使用经过验证的儿科观察量表区分幼儿ED和疼痛的可能性。
在获得机构批准并获得书面同意后，纳入接受择期腺样体切除术和/或扁桃体切除术的儿童。在标准化麻醉后，两名经过培训的观察员在拔管时以及术后5分钟、10分钟和15分钟，使用小儿麻醉苏醒期谵妄量表（PAED）和面部、腿部、活动、哭闹、安慰度量表（FLACC）同时评估儿童的行为。
在完成研究的150名儿童中，32名（21%）出现ED，7名（5%）出现疼痛，98名（65%）同时出现ED和疼痛。“无眼神接触”、“无有目的动作”和“无周围环境意识”（ED1）的关联对识别ED的敏感性为0.96，特异性为0.80（阳性预测值0.97，阴性预测值0.78）。“无法安慰”和“烦躁不安”（ED2）对识别疼痛的敏感性为0.69，特异性为0.88（阳性预测值0.83，阴性预测值0.78）。
使用FLACC和PAED评分难以区分ED和疼痛。“无眼神接触”、“无有目的动作”和“无周围环境意识”与ED显著相关。“无法安慰”和“烦躁不安”在苏醒后的前15分钟内用于识别疼痛或ED的可靠性不足。
