House L McLean, Calloway Nathan H, Sandberg Warren S, Ehrenfeld Jesse M
Department of Anesthesia and Perioperative Care, University of California, San Francisco, CA, USA.
Department of Otolaryngology, University of North Carolina, Chapel Hill, NC, USA.
J Anaesthesiol Clin Pharmacol. 2016 Oct-Dec;32(4):446-452. doi: 10.4103/0970-9185.194776.
Emergence time, or the duration between incision closure and extubation, is costly nonoperative time. Efforts to improve operating room efficiency and identify trainee progress make such time intervals of interest. We sought to calculate the incidence of prolonged emergence (i.e., >15 min) for patients under the care of clinical anesthesia (CA) residents. We also sought to identify factors from resident training, medical history, anesthetic use, and anesthesia staffing, which affect emergence.
In this single-center, historical cohort study, perioperative information management systems provided data for surgical cases under resident care at a tertiary care center in the United States from 2006 to 2008. Using multiple logistic regression, the effects of variables on emergence was analyzed.
Of 7687 cases under the care of 27 residents, the incidence of prolonged emergence was 13.9%. Emergence prolongation decreased by month in training for 1-year (CA-1) residents (r = 0.7, < 0.001), but not for CA-2 and CA-3 residents. Mean patient emergence time differed among 27 residents ( < 0.01 for 58.4% or 205/351 paired comparisons). In a model restricted to 1-year residents, patient male gender, American Society of Anesthesiologists (ASA) physical status >II, emergency surgical case, operative duration ≥2 h, and paralytic agent use were associated with higher frequency of prolonged emergence, while sevoflurane or desflurane use was associated with lower frequency. Attending anesthesiologist handoff was not associated with longer emergence.
Incidence of prolonged emergence from general anesthesia differed significantly among trainees, by resident training duration, and for patients with ASA >II.
苏醒时间，即切口缝合至拔管之间的时长，是成本高昂的非手术时间。提高手术室效率以及确定实习生进展的努力使得这样的时间间隔备受关注。我们试图计算临床麻醉（CA）住院医师所负责患者出现延长苏醒（即>15分钟）的发生率。我们还试图确定来自住院医师培训、病史、麻醉用药和麻醉人员配置等影响苏醒的因素。
在这项单中心回顾性队列研究中，围手术期信息管理系统提供了2006年至2008年美国一家三级医疗中心住院医师负责的手术病例数据。使用多元逻辑回归分析变量对苏醒的影响。
在27名住院医师负责的7687例病例中，延长苏醒的发生率为13.9%。一年级（CA-1）住院医师的苏醒延长率随培训月份下降（r = 0.7，P < 0.001），但CA-2和CA-3住院医师并非如此。27名住院医师的平均患者苏醒时间存在差异（351对配对比较中有58.4%或205对P < 0.01）。在仅纳入一年级住院医师的模型中，患者男性、美国麻醉医师协会（ASA）身体状况>II级、急诊手术病例、手术时长≥2小时以及使用麻痹剂与延长苏醒的较高频率相关，而使用七氟烷或地氟烷与较低频率相关。主治麻醉医师交接与更长的苏醒时间无关。
全身麻醉后延长苏醒的发生率在实习生之间、住院医师培训时长以及ASA>II级患者中存在显著差异。
