单色光可减少行扁桃体腺样体切除术患儿苏醒期谵妄；一项双盲随机观察性研究。

Monochromic light reduces emergence delirium in children undergoing adenotonsillectomy; a double-blind randomized observational study.

机构信息

Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, 6621 Fannin Street, Houston, TX, USA.

Baylor College of Medicine, Houston, TX, USA.

出版信息

BMC Anesthesiol. 2021 Sep 8;21(1):217. doi: 10.1186/s12871-021-01435-1.

DOI:10.1186/s12871-021-01435-1

PMID:34496743

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8424999/

Abstract

BACKGROUND

Emergence delirium (ED) is common in pediatric anesthesia. This dissociative state in which the patient is confused from their surroundings and flailing can be self-injurious and traumatic for parents. Treatment is by administration of sedatives which can prolong recovery. The aim of this study was to determine if exposure to monochromatic blue light (MBL) in the immediate phase of recovery could reduce the overall incidence of emergence delirium in children following general inhalational anesthesia.

METHODS

This double blinded randomized controlled study included patients ages 2-6 undergoing adenotonsillectomy. Postoperatively, 104 patients were randomization (52 in each group) for exposure to sham blue or MBL during the first phase (initial 30 min) of recovery. The primary outcome was the incidence of emergence delirium during the first phase. We also examined Pediatric Anesthesia Emergence Delirium (PAED) scores throughout the first phase.

RESULTS

Emergence Delirium was reported in 5.9% of MBL patients versus 33.3% in the sham group, p = 0.001. Using logistic regression adjusting for age, weight, gender, ASA classification and PAED scores provided an adjusted relative risk ratio of 0.18; 95% CI (0.06, 0.54); p = 0.001 for patients in the MBL group. 23.5% of MBL patients versus 52.9% of sham patients had either ED or PAED scores of 12 or more throughout the first phase of recovery, p = 0.002. This produced an adjusted relative risk of 0.46, 95% CI (0.29, 0.75), p = 0.001.

CONCLUSIONS

Monochromatic blue light represents a non-pharmacologic method to reduce the incidence of emergence delirium and PAED scores in children.

TRIAL REGISTRATION

#NCT03285243 registered on 15/09/2017.

摘要

背景

儿科麻醉中，苏醒期谵妄（ED）很常见。这种患者对周围环境感到困惑和挣扎的分离状态可能会对父母造成自我伤害和创伤。治疗方法是给予镇静剂，但这可能会延长恢复期。本研究旨在确定在恢复的初始阶段暴露于单色蓝光（MBL）是否可以降低接受全身吸入麻醉的儿童在苏醒期谵妄的总体发生率。

方法

这项双盲随机对照研究纳入了 2-6 岁行腺样体扁桃体切除术的患者。术后，104 例患者随机分为 52 例（每组 52 例），在恢复的第一阶段（最初 30 分钟）接受假蓝光或 MBL 暴露。主要结局是第一阶段出现苏醒期谵妄的发生率。我们还检查了整个第一阶段的儿科麻醉苏醒期谵妄（PAED）评分。

结果

MBL 组 5.9%的患者出现苏醒期谵妄，而假蓝光组 33.3%的患者出现苏醒期谵妄，p=0.001。使用调整年龄、体重、性别、ASA 分级和 PAED 评分的逻辑回归分析，MBL 组的调整相对风险比为 0.18；95%CI（0.06，0.54）；p=0.001。 MBL 组 23.5%的患者与假蓝光组 52.9%的患者在整个恢复的第一阶段出现 ED 或 PAED 评分≥12 分，p=0.002。这产生了调整后的相对风险 0.46，95%CI（0.29，0.75），p=0.001。