Umholtz Matthew, Cilnyk John, Wang Christopher K, Porhomayon Jahan, Pourafkari Leili, Nader Nader D
Department of Anesthesiology, University at Buffalo, Buffalo, NY, 14214.
Department of Anesthesiology, Sisters of Charity Catholic Health System, Buffalo, NY, 14215.
J Clin Anesth. 2016 Nov;34:3-10. doi: 10.1016/j.jclinane.2016.02.047. Epub 2016 May 2.
Recovery from anesthesia may be complicated with development of severe panic symptoms and anxiety. Preexisting anxiety disorder has been reported as a risk factor for development of these symptoms. We aimed to examine the frequency of emergence delirium (EDL) among veterans diagnosed with posttraumatic stress disorders (PTSDs).
Retrospective cohort.
Postoperative recovery area.
Perioperative information of 1763 consecutive patients who underwent a surgical procedure requiring general anesthesia were collected. The patients were grouped on the basis of previous diagnosis of PTSD. A total of 317 patients were identified with a positive history of PTSD and were compared to 1446 patients without such a history for the occurrence of EDL in the postanesthesia care unit (PACU) as the primary endpoint.
Duration of stay in PACU in minutes and the frequency of hospital admission were the secondary endpoints. Multivariate binary logistic regression analysis was performed to identify the predictors of EDL among the veteran population.
Emergence delirium was reported in 37 cases (2.1%) after general anesthesia. Fifteen (4.7%) of 317 patients with PTSD and 22 (1.5%) of 1446 patients without history of PTSD demonstrated symptoms related to EDL in the PACU (P=.002). After propensity matching, there were 8 patients with EDL in the PTSD group whereas there were only 2 patients with EDL among controls. Posttraumatic stress disorder was also an independent predictor of EDL in multivariate analysis with an odds ratio of 6.66 and a 95% confidence interval of 2.04 to 21.72 (P=.002).
Posttraumatic stress disorder independently predicted the frequency of EDL even after correcting for preexisting depression and anxiety disorders. A relatively longer duration of PACU stay in PTSD patients may reflect raised awareness of the health care workers about this debilitating mental disorder.
麻醉苏醒过程可能因出现严重的惊恐症状和焦虑而变得复杂。既往焦虑症被报道为出现这些症状的一个危险因素。我们旨在研究诊断为创伤后应激障碍（PTSD）的退伍军人中出现谵妄（EDL）的频率。
回顾性队列研究。
术后恢复区。
收集了1763例连续接受需要全身麻醉的外科手术患者的围手术期信息。患者根据既往PTSD诊断进行分组。共识别出317例有PTSD阳性病史的患者，并将其与1446例无此类病史的患者进行比较，将麻醉后护理单元（PACU）中EDL的发生作为主要终点。
以分钟为单位的PACU停留时间和住院频率为次要终点。进行多因素二元逻辑回归分析以确定退伍军人人群中EDL的预测因素。
全身麻醉后报告有37例（2.1%）出现谵妄。317例PTSD患者中有15例（4.7%），1446例无PTSD病史的患者中有22例（1.5%）在PACU出现与EDL相关的症状（P = 0.002）。倾向匹配后，PTSD组有8例出现EDL，而对照组仅有2例出现EDL。在多因素分析中，创伤后应激障碍也是EDL的独立预测因素，比值比为6.66，95%置信区间为2.04至21.72（P = 0.002）。
即使校正了既往存在的抑郁和焦虑症，创伤后应激障碍仍独立预测EDL的频率。PTSD患者在PACU停留时间相对较长可能反映了医护人员对这种使人衰弱的精神障碍的更高认识。
