Department of Anaesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA; Department of Anaesthesiology, Children's Hospital Colorado, Aurora, CO, USA.
Department of Anaesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
Br J Anaesth. 2018 Oct;121(4):776-786. doi: 10.1016/j.bja.2018.06.027. Epub 2018 Aug 10.
Circadian rhythms coordinate almost all physiological functions and are implicated in major disease development. Even though circadian rhythms have a major impact on human health, little is known about how they affect general anaesthesia. The purpose of this study was to understand if the time of day affects the length of time a child needs to achieve readiness for discharge after general anaesthesia for brain MRI.
A retrospective analysis over a 3 yr period (2013-5) on the length of stay in the postanaesthesia care unit (PACU) before discharge was performed for children (age <18 yr) undergoing brain magnetic resonance imaging as outpatients. PACU duration was correlated to either morning vs afternoon or to time clusters for discharge times (<9 AM, >9 AM <12 PM, >12 PM <3 PM, >3 PM <6 PM, >6 PM).
Data from 2340 procedures in children, with median age [inter-quartile range (range)] of 4.7 [2.3-7.25 (0.5-17.8)] yr were available for analysis. The length of stay in the PACU significantly increased over the course of the day with an observed maximum increase of 18 or 19 min (<9 AM vs >6 PM) in children older than 3 or 5 yr, respectively. Subgroup analysis suggested time of day dependent PACU time increase was independent of sex, co-medications, or obstructive sleep apnoea.
The time of day significantly affects PACU recovery times in children of both genders having brain imaging under general anaesthesia. Children younger than 3 yr might not be affected. Further validation of these findings may guide future strategies to reduce discharge times.
昼夜节律协调几乎所有的生理功能，并与主要疾病的发展有关。尽管昼夜节律对人类健康有重大影响，但人们对它们如何影响全身麻醉知之甚少。本研究旨在了解一天中的时间是否会影响接受脑部 MRI 全身麻醉后儿童达到出院准备状态的时间长短。
对 3 年（2013 年 5 月）期间在门诊接受脑部磁共振成像的儿童（年龄<18 岁）进行回顾性分析，分析术后恢复室（PACU）的停留时间与上午与下午或与出院时间的时间聚类（<9 AM、>9 AM <12 PM、>12 PM <3 PM、>3 PM <6 PM、>6 PM）相关。
共 2340 例儿童的数据可用于分析，中位年龄[四分位数范围（范围）]为 4.7 [2.3-7.25（0.5-17.8）]岁。PACU 的停留时间随着时间的推移而显著增加，3 岁或 5 岁以上的儿童分别观察到最大增加 18 或 19 分钟（<9 AM 与>6 PM）。亚组分析表明，日间 PACU 时间增加与性别、合并用药或阻塞性睡眠呼吸暂停无关。
昼夜节律显著影响接受全身麻醉脑部成像的男女儿童的 PACU 恢复时间。3 岁以下的儿童可能不受影响。进一步验证这些发现可能会指导未来减少出院时间的策略。
