Departments of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No.8 Xishiku Street, Beijing, 100034, China.
Departments of Anesthesiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China.
J Anesth. 2020 Oct;34(5):675-687. doi: 10.1007/s00540-020-02805-8. Epub 2020 Jun 7.
The clinical significance of emergence delirium remains unclear. The purpose of this study was to investigate the association between emergence delirium and postoperative delirium in elderly after general anesthesia and surgery.
This prospective observational study was done in a tertiary hospital in Beijing, China. Elderly patients (65-90 years) who underwent major noncardiac surgery under general anesthesia and admitted to the postanesthesia care unit (PACU) after surgery were enrolled. Emergence delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit during PACU stay. Postoperative delirium was assessed with the Confusion Assessment Method during the first 5 postoperative days. The association between emergence delirium and postoperative delirium was analyzed with a multivariable logistic regression model.
A total of 942 patients were enrolled and 915 completed the study. Emergence delirium developed in 37.0% (339/915) of patients during PACU stay; and postoperative delirium developed in 11.4% (104/915) of patients within the first 5 postoperative days. After adjusted confounding factors, the occurrence of emergence delirium is independently associated with an increased risk of postoperative delirium (OR 1.717, 95% CI 1.078-2.735, P = 0.023). Patients with emergence delirium stayed longer in PACU and hospital after surgery, and developed more non-delirium complications within 30 days.
Emergence delirium in elderly admitted to the PACU after general anesthesia and major surgery is independently associated with an increased risk of postoperative delirium. Patients with emergence delirium had worse perioperative outcomes. Chinese Clinical Trial Registry (chictr.org.cn) ChiCTR-OOC-17012734.
术后谵妄的临床意义尚不清楚。本研究旨在探讨全麻术后老年患者苏醒期谵妄与术后谵妄的关系。
这是一项在中国北京一家三级医院进行的前瞻性观察研究。纳入接受全麻下非心脏大手术、术后入住麻醉后恢复室（PACU）的老年患者（65-90 岁）。在 PACU 期间使用 ICU 意识模糊评估法（CAM-ICU）评估苏醒期谵妄，术后第 1-5 天使用 CAM 评估术后谵妄。采用多变量逻辑回归模型分析苏醒期谵妄与术后谵妄的关系。
共纳入 942 例患者，915 例完成研究。PACU 期间 37.0%（339/915）的患者发生苏醒期谵妄；术后第 1-5 天 11.4%（104/915）的患者发生术后谵妄。校正混杂因素后，苏醒期谵妄的发生与术后谵妄的发生风险增加独立相关（OR 1.717，95%CI 1.078-2.735，P=0.023）。发生苏醒期谵妄的患者在 PACU 和术后住院时间较长，术后 30 天内非谵妄并发症发生率更高。
全麻和大手术后入住 PACU 的老年患者苏醒期谵妄与术后谵妄的发生风险增加独立相关。发生苏醒期谵妄的患者围手术期结局更差。中国临床试验注册中心（ChiCTR-OOC-17012734）。
