From the Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children's Hospital (LC, CD, JML, NEL, IM, AT, AB, CBB), Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts (LC, CD, JML, NEL, IM, AT, AB, CBB) and School of Medicine, University of California, San Francisco, San Francisco, California, USA (NEL).
Eur J Anaesthesiol. 2018 Jan;35(1):49-59. doi: 10.1097/EJA.0000000000000739.
Few studies have systematically described relationships between clinical-behavioural signs, electroencephalographic (EEG) patterns and age during emergence from anaesthesia in young children.
To identify the relationships between end-tidal sevoflurane (ETsevoflurane) concentration, age and frontal EEG spectral properties in predicting recovery of clinical-behavioural signs during emergence from sevoflurane in children 0 to 3 years of age, with and without exposure to nitrous oxide. The hypothesis was that clinical signs occur sequentially during emergence, and that for infants aged more than 3 months, changes in alpha EEG power are correlated with clinical-behavioural signs.
An observational study.
A tertiary paediatric teaching hospital from December 2012 to August 2016.
Ninety-five children aged 0 to 3 years who required surgery below the neck.
Time-course of, and ETsevoflurane concentrations at first gross body movement, first cough, first grimace, dysconjugate eye gaze, frontal (F7/F8) alpha EEG power (8 to 12 Hz), frontal beta EEG power (13 to 30 Hz), surgery-end.
Clinical signs of emergence followed an orderly sequence of events across all ages. Clinical signs occurred over a narrow ETsevoflurane, independent of age [movement: 0.4% (95% confidence interval (CI), 0.3 to 0.4), cough 0.3% (95% CI, 0.3 to 0.4), grimace 0.2% (95% CI, 0 to 0.3); P > 0.5 for age vs. ETsevoflurane]. Dysconjugate eye gaze was observed between ETsevoflurane 1 to 0%. In children more than 3 months old, frontal alpha EEG oscillations were present at ETsevoflurane 2.0% and disappeared at 0.5%. Movement occurred within 5 min of alpha oscillation disappearance in 99% of patients. Nitrous oxide had no effect on the time course or ETsevoflurane at which children showed body movement, grimace or cough.
Several clinical signs occur sequentially during emergence, and are independent of exposure to nitrous oxide. Eye position is poorly correlated with other clinical signs or ETsevoflurane. EEG spectral characteristics may aid prediction of clinical-behavioural signs in children more than 3 months.
很少有研究系统描述小儿麻醉苏醒过程中临床行为体征、脑电图（EEG）模式与年龄之间的关系。
在小儿（0-3 岁）七氟醚麻醉苏醒过程中，确定呼气末七氟醚浓度、年龄与额部 EEG 频谱特征与临床行为体征恢复之间的关系，同时评估是否存在一氧化二氮（笑气）的影响。假设是临床体征在苏醒过程中依次出现，并且对于 3 个月以上的婴儿，α EEG 功率的变化与临床行为体征相关。
观察性研究。
2012 年 12 月至 2016 年 8 月三级儿科教学医院。
95 名年龄 0-3 岁需要行颈部以下手术的患儿。
首次出现躯体运动、首次咳嗽、首次面部表情、眼位分离、额部（F7/F8）α EEG 功率（8-12Hz）、额部β EEG 功率（13-30Hz）、手术结束时的时间进程和呼气末七氟醚浓度。
所有年龄段的苏醒过程中临床体征均按有序顺序出现。临床体征在较窄的七氟醚浓度范围内出现，与年龄无关[运动：0.4%（95%置信区间（CI），0.3-0.4），咳嗽 0.3%（95%CI，0.3-0.4），皱眉 0.2%（95%CI，0-0.3）；P>0.5 为年龄与呼气末七氟醚浓度]。眼位分离发生在呼气末七氟醚浓度 1%-0%之间。3 个月以上的儿童，额部α EEG 震荡出现在 2.0%的呼气末七氟醚浓度时，在 0.5%时消失。99%的患者在α EEG 消失后 5min 内出现运动。一氧化二氮对儿童出现躯体运动、皱眉或咳嗽的时间过程或呼气末七氟醚浓度没有影响。
苏醒过程中出现了多个临床体征，且与是否接触一氧化二氮无关。眼位与其他临床体征或呼气末七氟醚浓度相关性差。脑电图频谱特征可能有助于预测 3 个月以上儿童的临床行为体征。
