Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
Department of Clinical Sciences, Université de Montréal, St-Hyacinthe, QC, Canada.
Can J Anaesth. 2024 Aug;71(8):1117-1125. doi: 10.1007/s12630-024-02764-8. Epub 2024 May 8.
Children recovering from anesthesia commonly experience early postoperative negative behaviour, caused by pain and emergence delirium. Differentiating the two is challenging in young children. Perioperative pain influences the heart rate variability-derived Newborn Infant Parasympathetic Evaluation (NIPE) index and may also affect emergence delirium. We sought to investigate whether the perioperative NIPE index can discriminate between mild, moderate, or severe pain levels and can detect emergence delirium.
This prospective observational study enrolled children aged three years or younger undergoing elective adenotonsillectomy, tonsillectomy, or adenoidectomy. The NIPE index, the Faces, Legs, Activity, Cry, Consolability (FLACC) score, and the Pediatric Anesthesia Emergence Delirium (PAED) score were recorded in the postanesthesia care unit (PACU). The primary aim was to investigate the relationship between the postoperative NIPE index and postoperative pain severity. The secondary aims were to evaluate the association between the NIPE index and emergence delirium (PAED ≥ 10) and its delirium-specific (ED-I) and pain-specific (ED-II) components.
Sixty-nine children were recruited. In the PACU, the mean (standard deviation [SD]) NIPE values in children experiencing moderate and severe pain were 50 (12) and 49 (14), respectively. These values were significantly lower than the mean (SD) value of 64 (13) observed in children with mild pain (mean difference moderate vs no/mild pain, -14; 95% confidence interval [CI], -17 to -11; P < 0.001, and mean difference severe vs no/mild pain, -17; 95% CI, -20 to -14; P < 0.001, respectively). The NIPE index was significantly lower in children experiencing pain-specific ED-II (mean [SD] NIPE instantaneous [NIPEi] for ED-II 49 [10] vs no ED-II 55 [13]; mean difference, -6; 95% CI, -11 to -2; P = 0.009). The NIPE index was unable to detect emergence delirium (mean [SD] NIPEi for ED, 54 [15] vs no ED, 51 [10]; mean difference, 3; 95% CI, -2 to 8; P = 0.23) or the delirium-specific component ED-I (mean [SD] NIPEi for ED-I, 55 [15] vs no ED-I, 51 [11]; mean difference, 4; 95% CI, 0 to 8; P = 0.06).
The NIPE index can identify moderate and severe postoperative pain after adenotonsillectomy but not emergence delirium in children aged three years and younger. This discrimination can be valuable in the early postoperative phase when the differentiation between pain and emergence delirium is difficult.
ClinicalTrials.gov ( NCT04909060 ); first submitted 26 May 2021.
儿童在麻醉恢复期常出现术后早期负性行为，这是由疼痛和苏醒性谵妄引起的。在幼儿中区分这两者具有挑战性。围手术期疼痛会影响新生儿迷走神经评价（NIPE）指数，也可能影响苏醒性谵妄。我们旨在研究围手术期 NIPE 指数是否可以区分轻度、中度或重度疼痛程度，并可以检测苏醒性谵妄。
本前瞻性观察研究纳入了 3 岁及以下行腺样体切除术、扁桃体切除术或腺样体切除术的儿童。在麻醉后护理单元（PACU）记录 NIPE 指数、面部、腿部、活动、哭泣、安抚（FLACC）评分和儿科麻醉苏醒期谵妄（PAED）评分。主要目的是研究术后 NIPE 指数与术后疼痛严重程度之间的关系。次要目的是评估 NIPE 指数与苏醒性谵妄（PAED≥10）及其谵妄特异性（ED-I）和疼痛特异性（ED-II）成分之间的关联。
共纳入 69 名儿童。在 PACU 中，中度和重度疼痛患儿的 NIPE 值分别为 50（12）和 49（14），显著低于轻度疼痛患儿的 64（13）（中度 vs 无/轻度疼痛的平均差值，-14；95%置信区间，-17 至-11；P<0.001，重度 vs 无/轻度疼痛的平均差值，-17；95%置信区间，-20 至-14；P<0.001）。NIPE 指数在出现疼痛特异性 ED-II 的患儿中明显降低（ED-II 即刻 NIPEi 的平均值[标准差]为 49[10]，无 ED-II 为 55[13]；平均差值，-6；95%置信区间，-11 至-2；P=0.009）。NIPE 指数无法检测到苏醒性谵妄（ED 的平均值[标准差]NIPEi 为 54[15]，无 ED 为 51[10]；平均差值，3；95%置信区间，-2 至 8；P=0.23）或谵妄特异性成分 ED-I（ED-I 的平均值[标准差]NIPEi 为 55[15]，无 ED-I 为 51[11]；平均差值，4；95%置信区间，0 至 8；P=0.06）。
NIPE 指数可识别 3 岁及以下儿童腺样体切除术术后中度和重度疼痛，但不能识别苏醒性谵妄。在术后早期区分疼痛和苏醒性谵妄困难时，这种区分可能很有价值。
ClinicalTrials.gov（NCT04909060）；首次提交日期为 2021 年 5 月 26 日。
