Ramroop Renair, Hariharan Seetharaman, Chen Deryk
Eric Williams Medical Sciences Complex, The University of the West Indies, Faculty of Medical Sciences, Mount Hope, Trinidad and Tobago.
Eric Williams Medical Sciences Complex, The University of the West Indies, Faculty of Medical Sciences, Mount Hope, Trinidad and Tobago.
Braz J Anesthesiol. 2019 May-Jun;69(3):233-241. doi: 10.1016/j.bjan.2018.12.003. Epub 2019 May 7.
Emergence delirium after general anesthesia with sevoflurane has not been frequently reported in adults compared to children. This study aimed to determine the incidence of emergence delirium in adult patients who had anesthesia with sevoflurane as the volatile agent and the probable risk factors associated with its occurrence.
DESIGN & METHODS: A prospective observational study was conducted in adult patients who had non-neurological procedures and no existing neurological or psychiatric conditions, under general anesthesia. Demographic data such as age, gender, ethnicity and clinical data including ASA physical status, surgical status, intubation attempts, duration of surgery, intraoperative hypotension, drugs used, postoperative pain, rescue analgesia and presence of catheters were recorded. Emergence delirium intensity was measured using the Nursing Delirium Scale (NuDESC).
The incidence of emergence delirium was 11.8%. The factors significantly associated with emergence delirium included elderly age (>65) ( = 0.04), emergency surgery ( = 0.04), African ethnicity ( = 0.01), longer duration of surgery ( = 0.007) and number of intubation attempts ( = 0.001). Factors such as gender, alcohol and illicit drug use, and surgical specialty did not influence the occurrence of emergence delirium.
The incidence of emergence delirium in adults after general anesthesia using sevoflurane is significant and has not been adequately reported. Modifiable risk factors need to be addressed to further reduce its incidence.
与儿童相比,七氟醚全身麻醉后成人出现苏醒谵妄的情况报道较少。本研究旨在确定以七氟醚作为挥发性麻醉剂的成年患者苏醒谵妄的发生率及其发生的可能危险因素。
对接受非神经外科手术且无现有神经或精神疾病的成年患者进行全身麻醉下的前瞻性观察研究。记录年龄、性别、种族等人口统计学数据以及美国麻醉医师协会(ASA)身体状况、手术情况、插管尝试次数、手术时长、术中低血压、所用药物、术后疼痛、补救镇痛及导管留置情况等临床数据。使用护理谵妄量表(NuDESC)测量苏醒谵妄强度。
苏醒谵妄的发生率为11.8%。与苏醒谵妄显著相关的因素包括老年(>65岁)(P = 0.04)、急诊手术(P = 0.04)、非洲种族(P = 0.01)、手术时间较长(P = 0.007)及插管尝试次数(P = 0.001)。性别、饮酒和使用非法药物以及手术专科等因素不影响苏醒谵妄的发生。
七氟醚全身麻醉后成人苏醒谵妄的发生率较高且报道不足。需要解决可改变的危险因素以进一步降低其发生率。