Department of Anesthesiology, Peking University First Hospital, Beijing 100034, China.
Department of Anesthesiology, Peking University Cancer Hospital, Beijing 100142, China.
Chin Med J (Engl). 2023 Oct 5;136(19):2330-2339. doi: 10.1097/CM9.0000000000002375.
Emergence delirium (ED) is a kind of delirium that occured in the immediate post-anesthesia period. Lower body temperature on post-anesthesia care unit (PACU) admission was an independent risk factor of ED. The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery.
This study was a secondary analysis of a prospective observational study. Taking baseline body temperature as a reference, intraoperative absolute and relative temperature changes were calculated. The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference. ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge.
A total of 874 patients were analyzed with a mean age of 71.8 ± 5.3 years. The incidence of ED was 38.4% (336/874). When taking 36.0°C, 35.5°C, and 35.0°C as thresholds, the incidences of absolute hypothermia were 76.7% (670/874), 38.4% (336/874), and 17.5% (153/874), respectively. In multivariable logistic regression analysis, absolute hypothermia (lowest value <35.5°C) and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age, education, preoperative mild cognitive impairment, American Society of Anesthesiologists grade, duration of surgery, site of surgery, and pain intensity. Relative hypothermia (decrement >1.0°C from baseline) and its cumulative duration were also associated with an increased risk of ED, respectively. When taking the relative increment >0.5°C as a threshold, the incidence of relative hyperthermia was 21.7% (190/874) and it was associated with a decreased risk of ED after adjusting above confounders.
In the present study, we found that intraoperative hypothermia, defined as either absolute or relative hypothermia, was associated with an increased risk of ED in elderly patients after non-cardiac surgery. Relative hyperthermia, but not absolute hyperthermia, was associated with a decreased risk of ED.
Chinese Clinical Trial Registry (No. ChiCTR-OOC-17012734).
术后谵妄（ED）是一种在麻醉后即刻发生的谵妄。麻醉后恢复室（PACU）入院时体温较低是 ED 的独立危险因素。本研究旨在探讨非心脏手术老年患者术中体温与 ED 的关系。
本研究为前瞻性观察性研究的二次分析。以基础体温为参考，计算术中绝对和相对体温变化。相对变化定义为术中最低/最高体温与基础参考值之间的幅度。ED 采用 PACU 入住后 10 分钟和 30 分钟及 PACU 出院前使用重症监护病房意识模糊评估法进行评估。
共分析 874 例患者，平均年龄 71.8±5.3 岁。ED 发生率为 38.4%（336/874）。当以 36.0°C、35.5°C 和 35.0°C 为阈值时，绝对低体温的发生率分别为 76.7%（670/874）、38.4%（336/874）和 17.5%（153/874）。多变量 logistic 回归分析显示，在调整年龄、教育程度、术前轻度认知障碍、美国麻醉医师协会分级、手术时间、手术部位和疼痛强度等混杂因素后，绝对低体温（最低值<35.5°C）及其累积持续时间与 ED 风险增加相关。相对低体温（与基础值相比下降>1.0°C）及其累积持续时间也与 ED 风险增加相关。当以相对增量>0.5°C 为阈值时，相对高热的发生率为 21.7%（190/874），在调整上述混杂因素后，ED 风险降低。
本研究发现，术中低体温，无论是绝对低体温还是相对低体温，与非心脏手术后老年患者 ED 风险增加相关。相对高热，而不是绝对高热，与 ED 风险降低相关。
中国临床试验注册中心（注册号：ChiCTR-OOC-17012734）。
