From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Anesth Analg. 2023 Jun 1;136(6):1154-1163. doi: 10.1213/ANE.0000000000006470. Epub 2023 May 19.
Residual deep sedation during anesthesia recovery may predict postoperative complications. We examined the incidence and risk factors for deep sedation after general anesthesia.
We retrospectively reviewed health records of adults who underwent procedures with general anesthesia and were admitted to the postanesthesia care unit from May 2018 to December 2020. Patients were dichotomized by Richmond Agitation-Sedation Scale (RASS) score: ≤-4 (deeply sedated/unarousable) or ≥-3 (not deeply sedated). Anesthesia risk factors for deep sedation were assessed with multivariable logistic regression.
Of the 56,275 patients included, 2003 had a RASS ≤-4 (35.6 [95% CI, 34.1-37.2] cases per 1000 anesthetics administered). On adjusted analyses, the likelihood of a RASS ≤-4 increased when more soluble halogenated anesthetics were used. Compared with desflurane without propofol, the odds ratio (OR [95% CI]) for a RASS ≤-4 was higher with sevoflurane (1.85 [1.45-2.37]) and isoflurane (4.21 [3.29-5.38]) without propofol. Compared with desflurane without propofol, the odds of a RASS ≤-4 further increased with use of desflurane-propofol (2.61 [1.99-3.42]), sevoflurane-propofol (4.20 [3.28-5.39]), isoflurane-propofol (6.39 [4.90-8.34]), and total intravenous anesthesia (2.98 [2.22-3.98]). A RASS ≤-4 was also more likely with the use of dexmedetomidine (2.47 [2.10-2.89]), gabapentinoids (2.17 [1.90-2.48]), and midazolam (1.34 [1.21-1.49]). Deeply sedated patients discharged to general care wards had higher odds of opioid-induced respiratory complications (2.59 [1.32-5.10]) and higher odds of naloxone administration (2.93 [1.42-6.03]).
Likelihood of deep sedation after recovery increased with intraoperative use of halogenated agents with higher solubility and increased further when propofol was concomitantly used. Patients who experience deep sedation during anesthesia recovery have an increased risk of opioid-induced respiratory complications on general care wards. These findings may be useful for tailoring anesthetic management to reduce postoperative oversedation.
麻醉恢复期的残余深度镇静可能预测术后并发症。我们研究了全身麻醉后深度镇静的发生率和危险因素。
我们回顾性分析了 2018 年 5 月至 2020 年 12 月期间接受全身麻醉并入住麻醉后监护病房的成年人的健康记录。患者按 Richmond 镇静-躁动评分（RASS）评分分为两组：≤-4（深度镇静/无法唤醒）或≥-3（未深度镇静）。使用多变量逻辑回归评估麻醉深度镇静的危险因素。
在 56275 例患者中，有 2003 例 RASS ≤-4（每 1000 例麻醉中发生 35.6[95%CI，34.1-37.2]例）。在调整分析中，使用溶解度更高的卤代麻醉剂时，RASS ≤-4 的可能性增加。与无丙泊酚的地氟醚相比，无丙泊酚的七氟醚（1.85[1.45-2.37]）和异氟醚（4.21[3.29-5.38]）的 RASS ≤-4 比值比（OR[95%CI]）更高。与无丙泊酚的地氟醚相比，使用地氟醚-丙泊酚（2.61[1.99-3.42]）、七氟醚-丙泊酚（4.20[3.28-5.39]）、异氟醚-丙泊酚（6.39[4.90-8.34]）和全静脉麻醉（2.98[2.22-3.98]）时，RASS ≤-4 的可能性进一步增加。使用右美托咪定（2.47[2.10-2.89]）、加巴喷丁类药物（2.17[1.90-2.48]）和咪达唑仑（1.34[1.21-1.49]）也更有可能出现 RASS ≤-4。在普通护理病房出院的深度镇静患者发生阿片类药物引起的呼吸并发症的几率更高（2.59[1.32-5.10]），需要使用纳洛酮的几率更高（2.93[1.42-6.03]）。
术中使用溶解度更高的卤代麻醉剂和同时使用丙泊酚会增加麻醉恢复期深度镇静的可能性，当两者同时使用时，深度镇静的可能性进一步增加。在普通护理病房经历深度镇静的麻醉恢复期患者发生阿片类药物引起的呼吸并发症的风险增加。这些发现可能有助于调整麻醉管理以减少术后过度镇静。
