全麻后适合从麻醉后恢复室出院的患者的认知状态：地氟醚与丙泊酚的随机比较。
Cognitive status of patients judged fit for discharge from the post-anaesthesia care unit after general anaesthesia: a randomized comparison between desflurane and propofol.
机构信息
Department of Anaesthesia and Critical Care, Clinique Mutualiste de Pessac, Pessac, France.
Department of Anaesthesia and Critical Care, St-Antoine Hospital. Assistance Publique-Hôpitaux de Paris, 75012, Paris, France.
出版信息
BMC Anesthesiol. 2021 Mar 11;21(1):76. doi: 10.1186/s12871-021-01287-9.
BACKGROUND
The Aldrete's score is used to determine when a patient can safely leave the Post-Anaesthesia Care Unit (PACU) and be transferred to the surgical ward. The Aldrete score is based on the evaluation of vital signs and consciousness. Cognitive functions according to the anaesthetic strategy at the time the patient is judged fit for discharge from the PACU (Aldrete's score ≥ 9) have not been previously studied. The aim of this trial was to assess the cognitive status of inpatients emerging either from desflurane or propofol anaesthesia, at the time of PACU discharge (Aldrete score ≥ 9).
METHODS
Sixty adult patients scheduled for hip or knee arthroplasty under general anaesthesia were randomly allocated to receive either desflurane or propofol anaesthesia. Patients were evaluated the day before surgery using Digit Symbol Substitution Test (DSST), Stroop Color Test and Verbal Learning Test. After surgery, the Aldrete score was checked every 5 min until reaching a score ≥ 9. At this time, the same battery of cognitive tests was applied. Each test was evaluated separately. Cognitive status was reported using a combined Z score pooling together the results of all 3 cognitive tests.
RESULTS
Among the 3 tests, only DSST was significantly reduced at Aldrete Score ≥ 9 in the Desflurane group. Combined Z-scores at Aldrete Score ≥ 9 were (in medians [interquartils]): - 0.2 [- 1.2;+ 0.6] and - 0.4 [- 1.1;+ 0.4] for desflurane and propofol groups respectively (P = 0.62). Cognitive dysfunction at Aldrete score ≥ 9 was observed in 3 patients in the Propofol group and in 2 patients in the Desflurane group) (P = 0.93).
CONCLUSION
No difference was observed in cognitive status at Aldrete score ≥ 9 between desflurane and propofol anaesthesia. Although approximately 10% of patients still had cognitive dysfunctions, an Aldrete score ≥ 9 was associated with satisfactory cognitive function recovery in the majority of the patients after lower limb arthroplasty surgery under general anaesthesia.
TRIAL REGISTRATION
Clinical Trials identifier NTC02036736 .
背景
Aldrete 评分用于确定患者何时可以安全离开麻醉后恢复室（PACU）并转移到外科病房。Aldrete 评分基于生命体征和意识的评估。根据患者从 PACU 出院时的麻醉策略（Aldrete 评分≥9）判断是否适合出院时的认知功能尚未进行过研究。本试验旨在评估接受地氟烷或异丙酚麻醉的 PACU 出院时（Aldrete 评分≥9）患者的认知状态。
方法
60 名择期接受全身麻醉下髋关节或膝关节置换术的成年患者被随机分配接受地氟烷或异丙酚麻醉。患者在手术前一天使用数字符号替代测试（DSST）、Stroop 颜色测试和词语学习测试进行评估。手术后，每 5 分钟检查一次 Aldrete 评分，直到达到评分≥9。此时，应用相同的认知测试组合。单独评估每个测试。使用合并的 Z 分数报告认知状态，该分数合并了所有 3 个认知测试的结果。
结果
在 3 项测试中，只有在 Aldrete 评分≥9 时，地氟烷组的 DSST 显著降低。在 Aldrete 评分≥9 时的合并 Z 分数中位数（四分位距）分别为：-0.2[-1.2；+0.6]和-0.4[-1.1；+0.4]，地氟烷组和异丙酚组分别为（P=0.62）。在异丙酚组中，有 3 名患者和地氟烷组中 2 名患者在 Aldrete 评分≥9 时出现认知功能障碍（P=0.93）。
结论
地氟烷和异丙酚麻醉在 Aldrete 评分≥9 时的认知状态无差异。尽管约 10%的患者仍存在认知障碍，但 Aldrete 评分≥9 与下肢关节置换手术后大多数患者的满意认知功能恢复相关。
试验注册
临床试验标识符 NTC02036736。
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