Inoue Satoki, Abe Ryuichi, Tanaka Yuu, Kawaguchi Masahiko
Nara Medical University, Department of Anesthesiology and Division of Intensive Care, Shijo-cho Kashihara, Nara, Japão.
Nara Medical University, Department of Anesthesiology and Division of Intensive Care, Shijo-cho Kashihara, Nara, Japão.
Rev Bras Anestesiol. 2017 May-Jun;67(3):251-257. doi: 10.1016/j.bjan.2016.02.016. Epub 2017 Mar 1.
The memory of emergence from anesthesia is recognized as one type of anesthesia awareness. Apart from planed awake extubation, unintentional recall of tracheal extubation is thought to be the results of inadequate anesthesia management; therefore, the incidence can be related with the experience of anesthetists. To assess whether the incidence of recall of tracheal extubation is related to anesthetists' experience, we compared the incidence of recall of tracheal extubation between patients managed by anesthesia residents or by experienced anesthetists.
This is a retrospective review of an institutional registry containing 21,606 general anesthesia cases and was conducted with the board of ethical review approval. All resident tracheal extubations were performed under anesthetists' supervision. To avoid channeling bias, propensity score analysis was used to generate a set of matched cases (resident managements) and controls (anesthetist managements), yielding 3,475 matched patient pairs. The incidence of recall of tracheal extubation was compared as primary outcomes.
In the unmatched population, there was no difference in the incidences of recall of tracheal extubation between resident management and anesthetist management (6.5% vs. 7.1%, p=0.275). After propensity score matching, there was still no difference in incidences of recall of tracheal extubation (7.1% vs. 7.0%, p=0.853).
In conclusion, when supervised by an anesthetist, resident extubations are no more likely to result in recall than anesthetist extubations.
麻醉苏醒期记忆被认为是一种麻醉知晓类型。除了计划性清醒拔管外，气管拔管时的意外回忆被认为是麻醉管理不当的结果；因此，其发生率可能与麻醉医生的经验有关。为评估气管拔管回忆的发生率是否与麻醉医生的经验有关，我们比较了由住院麻醉医生或经验丰富的麻醉医生管理的患者中气管拔管回忆的发生率。
这是一项对包含21606例全身麻醉病例的机构登记资料进行的回顾性研究，并获得了伦理审查委员会的批准。所有住院医生进行的气管拔管均在麻醉医生的监督下进行。为避免选择偏倚，采用倾向评分分析生成一组匹配病例（住院医生管理）和对照（麻醉医生管理），得到3475对匹配患者。将气管拔管回忆的发生率作为主要结局进行比较。
在未匹配人群中，住院医生管理组和麻醉医生管理组的气管拔管回忆发生率无差异（6.5%对7.1%，p = 0.275）。倾向评分匹配后，气管拔管回忆发生率仍无差异（7.1%对7.0%，p = 0.853）。
总之，在麻醉医生的监督下，住院医生进行气管拔管导致回忆的可能性并不高于麻醉医生进行气管拔管。
