Shinoura Hiroshi, Ooshima Yuuri, Sato Hiroshi
Department of Anesthesia, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
BJA Open. 2023 Jun 19;7:100147. doi: 10.1016/j.bjao.2023.100147. eCollection 2023 Sep.
Tracheal extubation is a critical stage in the management of general anaesthesia during which serious complications may occur. Immediately before extubation, patients often exhibit signs that suggest that they are awake and experiencing discomfort. There is concern that patients may retain such memories of the extubation process. However, previous studies have not examined patient recall of extubation in detail. We therefore investigated the frequency of recall of discomfort during extubation, as well as first orientation to place, and other recollections upon emerging from general anaesthesia.
In a prospective observational study, 818 patients were interviewed during routine post-anaesthesia rounds on the day after general anaesthesia. The primary outcome was the proportion of patients recalling discomfort during extubation. The secondary outcome was the location of orientation to place upon emerging from general anaesthesia.
Recall of discomfort during extubation was uncommon, at 1.1% (=9; 95% confidence interval [CI]: 0.5-2.1%). Only 3.1% of patients recalled the extubation process at all (=25; 95% CI: 2.0-4.5%). The first orientation to place was most commonly in transit to a ward, in 41% of cases (=337; 95% CI: 38-45%).
Recall of discomfort during extubation appears to be rare, and the great majority of patients may not retain any memory of the extubation process. This information may be used to reassure patients and guide extubation practices for anaesthetists.
UMIN Clinical Trials Registry (UMIN000046136).
气管拔管是全身麻醉管理中的关键阶段，在此期间可能会发生严重并发症。在拔管前，患者通常会表现出表明其已苏醒且感到不适的迹象。有人担心患者可能会记住拔管过程。然而，既往研究尚未详细调查患者对拔管的回忆情况。因此，我们调查了拔管期间不适回忆的频率，以及全麻苏醒后首次对地点的定向情况和其他回忆。
在一项前瞻性观察研究中，对818例患者在全麻后次日的常规麻醉后查房期间进行了访谈。主要结局是回忆起拔管期间不适的患者比例。次要结局是全麻苏醒后对地点的定向位置。
拔管期间回忆起不适的情况并不常见，为1.1%（=9例；95%置信区间[CI]：0.5-2.1%）。仅有3.1%的患者回忆起了拔管过程（=25例；95%CI：2.0-4.5%）。首次对地点的定向最常见于转运至病房时，41%的病例如此（=337例；95%CI：38-45%）。
拔管期间回忆起不适似乎很罕见，绝大多数患者可能不会保留对拔管过程的任何记忆。这些信息可用于安抚患者，并为麻醉医生指导拔管操作。
日本大学医学情报网临床试验注册中心（UMIN000046136）。
