Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States; Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC), Mayo Clinic, Rochester, MN, United States.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, United States.
J Clin Anesth. 2017 Sep;41:120-125. doi: 10.1016/j.jclinane.2017.04.008. Epub 2017 Apr 19.
To compare the perioperative outcomes between patients with narcolepsy and matched controls undergoing anesthetic management.
Retrospective 2:1 matched study design.
Large tertiary medical center.
Narcoleptic patients who underwent general anesthesia from January 1, 2011, through September 30, 2015, were matched with controls by age, sex, and type and year of surgery.
Medical records were reviewed for episodes of respiratory depression during phase I recovery and for other meaningful perioperative outcomes.
The perioperative courses of 76 narcoleptic patients and their controls were examined. Compared to controls, narcoleptic patients were more often prescribed central nervous system stimulants (73.7% vs 4.0%, P<0.001) and antidepressants (46.1% vs 27.6%, P=0.007) and more often had obstructive sleep apnea (40.8% vs 19.1%, P<0.001). The intraoperative course was similar. The number of episodes of respiratory depression was not different between patients and controls (5 [6.6%] vs 12 [7.9%], respectively; P=0.80). Narcoleptic patients had a higher frequency of emergency response team activations (5 of 76 [6.6%]; 95% CI, 2.2%-14.7%) compared to controls (2 of 152 [1.3%]; 95% CI, 0.2%-4.7%) (P=0.04). Hemodynamic instability was the indication for all emergency response team activations except 1, which was for a narcoleptic patient who had excessive postoperative sedation and respiratory depression.
Narcoleptic patients had similar intraoperative courses as the matched controls, including phase I anesthetic recovery. However, they had a higher rate of emergency response team activations than the controls, which suggests that patients with narcolepsy may be at increased perioperative risk.
比较行全身麻醉的发作性睡病患者与匹配对照者的围术期结局。
回顾性 2:1 匹配研究设计。
大型三级医疗中心。
2011 年 1 月 1 日至 2015 年 9 月 30 日间行全身麻醉的发作性睡病患者，通过年龄、性别以及手术类型和年份与对照者匹配。
回顾病历以评估Ⅰ期恢复时呼吸抑制的发作情况以及其他有意义的围术期结局。
共检查了 76 例发作性睡病患者及其对照者的围术期过程。与对照者相比，发作性睡病患者更常被开具中枢神经系统兴奋剂（73.7%比 4.0%，P<0.001）和抗抑郁药（46.1%比 27.6%，P=0.007），且更常患有阻塞性睡眠呼吸暂停（40.8%比 19.1%，P<0.001）。术中过程相似。患者与对照者的呼吸抑制发作次数无差异（分别为 5 次[6.6%]和 12 次[7.9%]；P=0.80）。与对照者（2 of 152 [1.3%]；95%CI，0.2%-4.7%）相比，发作性睡病患者的应急反应小组激活率更高（5 of 76 [6.6%]；95%CI，2.2%-14.7%）（P=0.04）。除了 1 例外，所有应急反应小组激活的指征均为血流动力学不稳定，该例外患者为发作性睡病患者，其术后镇静和呼吸抑制过度。
发作性睡病患者的术中过程与匹配对照者相似，包括Ⅰ期麻醉恢复。然而，他们的应急反应小组激活率高于对照者，这表明发作性睡病患者的围术期风险可能增加。
