Department of Anesthesia, The People's Hospital of Kaizhou District, Chongqing, China.
Department of Anesthesia, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Acta Anaesthesiol Scand. 2021 Jul;65(6):719-729. doi: 10.1111/aas.13774. Epub 2021 Jan 7.
Emergence agitation (EA) is an adverse post-operative complication that increases the risk for injury, self-extubation, hemorrhages, and prolonged hospitalization. This meta-analysis aims to define the risk factors for adult EA after general anesthesia and provide recommendations for clinical practice.
Embase, PubMed, Medline, and the Cochrane Library databases were comprehensive retrieved. Observational studies that reported the risk factors for adult EA were enrolled. Review Manager 5.4 was used to analyze the extracted data.
Eighteen observational studies involving 16, 678 adult patients were enrolled in this study. Eighteen pre-operative and nineteen intraoperative factors with unadjusted data, and five pre-operative and five intraoperative factors with adjusted data were meta-analyzed separately. Among them, seven factors (age, male, smoking, history of substance misuse, inhalational anesthesia, urinary catheter, complain of pain, or need analgesic drug use in post-anesthetic care unit) were the risk factors no matter meta-analyzed by unadjusted data or adjusted data. Intraoperative use of benzodiazepines was the risk factor when meta-analyzed by adjusted data, but not unadjusted data. Moreover, age and inhalational anesthesia were not the risk factors when omitted one study for sensitivity analysis, and history of substance misuse could not do sensitivity analysis.
Based on this meta-analysis, male, smoking, urinary catheter, and post-operative pain are the risk factors, while age, inhalational anesthesia, history of substance misuse, and intraoperative use of benzodiazepines are the possible risk factors for adult EA.
This systematic review and meta-analysis identify risk factors associated with the occurrence of agitation during emergence from general anesthesia. As might be expected, the strongest factors are generally things which are irritating or painful for patients, but cannot necessarily be avoided.
苏醒期躁动（EA）是一种术后不良并发症，会增加受伤、自行拔管、出血和住院时间延长的风险。本荟萃分析旨在确定全身麻醉后成人 EA 的危险因素，并为临床实践提供建议。
全面检索 Embase、PubMed、Medline 和 Cochrane 图书馆数据库。纳入报告成人 EA 危险因素的观察性研究。使用 Review Manager 5.4 分析提取的数据。
本研究共纳入 18 项观察性研究，涉及 16678 例成年患者。分别对 18 项术前和 19 项术中因素（无调整数据）以及 5 项术前和 5 项术中因素（调整数据）进行荟萃分析。其中，7 个因素（年龄、男性、吸烟、物质使用障碍史、吸入麻醉、导尿管、在麻醉后恢复室抱怨疼痛或需要使用镇痛药）无论通过无调整数据还是调整数据进行荟萃分析，都是危险因素。术中使用苯二氮䓬类药物是调整数据进行荟萃分析的危险因素，但不是无调整数据的危险因素。此外，进行敏感性分析时排除一项研究后，年龄和吸入麻醉不是危险因素，而物质使用障碍史则无法进行敏感性分析。
基于本荟萃分析，男性、吸烟、导尿管和术后疼痛是危险因素，而年龄、吸入麻醉、物质使用障碍史和术中使用苯二氮䓬类药物是成人 EA 的可能危险因素。
本系统评价和荟萃分析确定了与全身麻醉后躁动发生相关的危险因素。正如预期的那样，最强的因素通常是对患者有刺激性或痛苦的事情，但不一定可以避免。
