Lütze Christian, Weber Thomas P, Lücke Thomas, Gude Philipp, Georgevici Adrian-Iustin
Department of Anesthesiology, St. Josef and St. Elisabeth Hospital, Ruhr University Bochum, Bochum, Germany -
Department of Anesthesiology, St. Josef and St. Elisabeth Hospital, Ruhr University Bochum, Bochum, Germany.
Minerva Anestesiol. 2024 Jul-Aug;90(7-8):644-653. doi: 10.23736/S0375-9393.24.17847-9.
Emergence delirium is a complication of pediatric anesthesia during the early recovery period. Children undergoing ear, nose, and throat surgery are at high risk. The Pediatric Assessment of Emergence Delirium (PAED) scale is used for diagnosis and founded to specify the degree of emergence delirium. However, there is no consensus regarding a threshold value for emergence delirium diagnosis. Homeostasis-guided pediatric general anesthesia aims to maintain physiological parameters within normal ranges. In this prospective, observational study we evaluated the incidence of emergence delirium in children undergoing elective ear, nose, and throat surgery under standardized homeostasis-guided general anesthesia. Secondarily, we identified risk factors associated with an increased PAED score.
In children aged 0-6 years, we collected data from standard monitoring, depth of anesthesia, and preoperative glucose and ketone body levels. These variables were studied as risk or protective factors for increased PAED >0 scores using multivariate logistic regression.
Of the 105 children analyzed, only five children (4.7%) had emergence delirium according to a threshold PAED score ≥10, while 37 children (35%) had PAED scores >0. Statistical analysis of the PAED outcome identified two significant positive associations with pain (P<0.001) and preoperative blood glucose levels (P=0.006) and one negative association with preoperative ketone body levels (P<0.001).
Our cohort observed a lower incidence of emergence delirium than in the literature. Higher pain intensity and lower blood glucose levels were risk factors for PAED > 0, whereas preoperative ketone body levels were protective.
苏醒期谵妄是小儿麻醉早期恢复阶段的一种并发症。接受耳鼻喉手术的儿童风险较高。小儿苏醒期谵妄评估（PAED）量表用于诊断，并已确立以明确苏醒期谵妄的程度。然而，关于苏醒期谵妄诊断的阈值尚无共识。内稳态导向的小儿全身麻醉旨在将生理参数维持在正常范围内。在这项前瞻性观察研究中，我们评估了在标准化内稳态导向全身麻醉下接受择期耳鼻喉手术的儿童中苏醒期谵妄的发生率。其次，我们确定了与PAED评分升高相关的危险因素。
对于0至6岁的儿童，我们收集了来自标准监测、麻醉深度以及术前血糖和酮体水平的数据。使用多因素逻辑回归分析这些变量作为PAED>0评分升高的风险或保护因素。
在分析的105名儿童中，根据PAED阈值评分≥10，只有5名儿童（4.7%）出现苏醒期谵妄，而37名儿童（35%）的PAED评分>0。对PAED结果的统计分析确定了与疼痛（P<0.001）和术前血糖水平（P=0.006）有两个显著的正相关，以及与术前酮体水平有一个负相关（P<0.001）。
我们的队列观察到的苏醒期谵妄发生率低于文献报道。较高的疼痛强度和较低的血糖水平是PAED>0的危险因素，而术前酮体水平具有保护作用。
