Miyake Tomoaki, Miyamoto Yoshihisa, Nakamura Nobuhito
Department of Anesthesia, Kanagawa Children's Medical Center, Yokohama, Japan.
Department of Anesthesiology, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan.
J Anesth. 2023 Aug;37(4):546-554. doi: 10.1007/s00540-023-03201-8. Epub 2023 May 16.
Anesthesia maintenance using propofol and a propofol bolus dose at the end of surgery have been shown to prevent emergence agitation (EA). However, the preventive effect of subanesthetic propofol infusion during sevoflurane anesthesia on EA remains unknown. We aimed to evaluate the effect of subanesthetic propofol infusion on EA in children.
We retrospectively compared the incidences of severe EA requiring pharmacological intervention in children who underwent adenoidectomy, tonsillectomy with or without adenoidectomy, or strabismus surgery between maintenance with sevoflurane alone (sevoflurane group) and maintenance with subanesthetic propofol with sevoflurane (combination group). A multivariable logistic regression model adjusted for confounders was used to assess the association between anesthesia methods and the occurrence of EA. Additionally, we estimated the direct effect of anesthesia methods by a mediation analysis, excluding the indirect effects of intraoperative fentanyl and droperidol administration.
Among 244 eligible patients, 132 and 112 were in the sevoflurane and combination groups, respectively. The crude incidence of EA was significantly lower in the combination group (17.0% [n = 19]) than in the sevoflurane group (33.3% [n = 44]) (P = 0.005). After adjusting for confounders, the incidence of EA was still significantly lower in the combination group (adjusted odds ratio [aOR]: 0.48, 95% confidence interval [CI] 0.25-0.91). The mediation analysis revealed a direct association of anesthesia methods with a lower EA incidence in the combination group (aOR: 0.48, 95% CI 0.24-0.93) than in the sevoflurane group.
Subanesthetic propofol infusion may effectively prevent severe EA requiring the administration of opioids or sedatives.
已证实使用丙泊酚维持麻醉以及在手术结束时给予丙泊酚推注剂量可预防苏醒期躁动（EA）。然而，在七氟醚麻醉期间给予亚麻醉剂量的丙泊酚输注对EA的预防效果尚不清楚。我们旨在评估亚麻醉剂量的丙泊酚输注对儿童EA的影响。
我们回顾性比较了单纯使用七氟醚维持麻醉（七氟醚组）和使用亚麻醉剂量的丙泊酚联合七氟醚维持麻醉（联合组）的接受腺样体切除术、扁桃体切除术（伴或不伴腺样体切除术）或斜视手术的儿童中需要药物干预的严重EA的发生率。使用调整了混杂因素的多变量逻辑回归模型来评估麻醉方法与EA发生之间的关联。此外，我们通过中介分析估计了麻醉方法的直接效应，排除了术中给予芬太尼和氟哌利多的间接效应。
在244名符合条件的患者中，七氟醚组和联合组分别有132名和112名。联合组EA的粗发生率（17.0% [n = 19]）显著低于七氟醚组（33.3% [n = 44]）（P = 0.005）。在调整混杂因素后，联合组EA的发生率仍然显著较低（调整后的优势比[aOR]：0.48，95%置信区间[CI] 0.25 - 0.91）。中介分析显示，联合组中麻醉方法与较低的EA发生率直接相关（aOR：0.48，95% CI 0.24 - 0.93），低于七氟醚组。
亚麻醉剂量的丙泊酚输注可能有效地预防需要给予阿片类药物或镇静剂的严重EA。
