Sanders Robert D, Gaskell Amy, Raz Aeyal, Winders Joel, Stevanovic Ana, Rossaint Rolf, Boncyk Christina, Defresne Aline, Tran Gabriel, Tasbihgou Seth, Meier Sascha, Vlisides Phillip E, Fardous Hussein, Hess Aaron, Bauer Rebecca M, Absalom Anthony, Mashour George A, Bonhomme Vincent, Coburn Mark, Sleigh Jamie
From the Department of Anesthesiology, University of Wisconsin-Madison, Madison, Wisconsin (R.D.S., A.R., C.B., A.H., R.M.B.); Department of Anesthesia, Rambam Healthcare Campus, Haifa, Israel (A.R.); Department of Anesthesiology and Critical Care, Houston Methodist Hospital, Houston, Texas (R.M.B.); Department of Anaesthesia, Waikato Clinical School, University of Auckland, Hamilton, New Zealand (A.G., J.W., J.S.); Department of Anesthesiology; University Hospital RWTH Aachen, Aachen, Germany (A.S., R.R., M.C.); Department of Anesthesia and Intensive Care Medicine, CHU University Hospital of Liège, Liège, Belgium (A.D., G.T., V.B.); University Department of Anesthesia and Intensive Care Medicine, CHR Citadelle and CHU University Hospital of Liège, Liège, Belgium (A.D., G.T., V.B.); Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands, (S.T., S.M., A.A.); and Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan (P.E.V., H.F., G.A.M.).
Anesthesiology. 2017 Feb;126(2):214-222. doi: 10.1097/ALN.0000000000001479.
The isolated forearm technique allows assessment of consciousness of the external world (connected consciousness) through a verbal command to move the hand (of a tourniquet-isolated arm) during intended general anesthesia. Previous isolated forearm technique data suggest that the incidence of connected consciousness may approach 37% after a noxious stimulus. The authors conducted an international, multicenter, pragmatic study to establish the incidence of isolated forearm technique responsiveness after intubation in routine practice.
Two hundred sixty adult patients were recruited at six sites into a prospective cohort study of the isolated forearm technique after intubation. Demographic, anesthetic, and intubation data, plus postoperative questionnaires, were collected. Univariate statistics, followed by bivariate logistic regression models for age plus variable, were conducted.
The incidence of isolated forearm technique responsiveness after intubation was 4.6% (12/260); 5 of 12 responders reported pain through a second hand squeeze. Responders were younger than nonresponders (39 ± 17 vs. 51 ± 16 yr old; P = 0.01) with more frequent signs of sympathetic activation (50% vs. 2.4%; P = 0.03). No participant had explicit recall of intraoperative events when questioned after surgery (n = 253). Across groups, depth of anesthesia monitoring values showed a wide range; however, values were higher for responders before (54 ± 20 vs. 42 ± 14; P = 0.02) and after (52 ± 16 vs. 43 ± 16; P = 0.02) intubation. In patients not receiving total intravenous anesthesia, exposure to volatile anesthetics before intubation reduced the odds of responding (odds ratio, 0.2 [0.1 to 0.8]; P = 0.02) after adjustment for age.
Intraoperative connected consciousness occurred frequently, although the rate is up to 10-times lower than anticipated. This should be considered a conservative estimate of intraoperative connected consciousness.
孤立前臂技术可通过在预期全身麻醉期间下达移动手部（使用止血带隔离的手臂）的口头指令来评估对外界的意识（关联意识）。先前的孤立前臂技术数据表明，有害刺激后关联意识的发生率可能接近37%。作者开展了一项国际多中心实用研究，以确定常规实践中插管后孤立前臂技术反应性的发生率。
在六个地点招募了260例成年患者，进行插管后孤立前臂技术的前瞻性队列研究。收集了人口统计学、麻醉和插管数据以及术后问卷。进行了单变量统计，随后对年龄加变量进行双变量逻辑回归模型分析。
插管后孤立前臂技术反应性的发生率为4.6%（12/260）；12名有反应者中有5人通过再次手部挤压报告疼痛。有反应者比无反应者年轻（39±17岁对51±16岁；P = 0.01），交感神经激活迹象更频繁（50%对2.4%；P = 0.03）。术后接受询问时，没有参与者对术中事件有明确回忆（n = 253）。各组间，麻醉深度监测值范围较广；然而，有反应者插管前（54±20对42±14；P = 0.02）和插管后（52±16对43±16；P = 0.02）的值更高。在未接受全静脉麻醉的患者中，插管前接触挥发性麻醉剂会降低反应几率（优势比，0.2[0.1至0.8]；P = 0.02），年龄校正后也是如此。
术中关联意识频繁发生，尽管发生率比预期低多达10倍。这应被视为术中关联意识的保守估计。
