Wei Wei, Xie Haihang, Xu Yingyi, Qin Jingwen, Guo Xinying, Song Xingrong, Yu Gaofeng, Zhang Na, Ma Daqing, Tan Yonghong, Zhao Tianyun
Department of Anesthesiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Division of Anaesthetics, Pain Medicine & Intensive Care, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom.
Front Pediatr. 2024 Oct 16;12:1437460. doi: 10.3389/fped.2024.1437460. eCollection 2024.
Emergence delirium (ED) is a widely recognized issue that prolongs mechanical ventilation and post-anesthesia care unit (PACU) resuscitation time, consequently increasing hospital costs and mortality. Postoperative disturbance in circadian rhythms, commonly leading to sleep disorders, has been identified as a significant risk factor for ED. However, the influence of surgery timing (morning vs. afternoon) on the incidence of ED in pediatric patients undergoing general anesthesia remains unknown.
Patients aged 2-6 years who were operated on under general anesthesia with a bispectral index value between 50 and 60 were categorized based on anesthesia start time into either the morning surgery group (Group M, 8:00-12:00) or the afternoon surgery group (Group A, 13:00-17:00). The primary outcome was the post-extubation incidence of ED assessed by the Cornell Assessment of Pediatric Delirium (CAPD) score. Secondary outcomes included extubation time, duration of PACU stay, and adverse postoperative events and complications.
We recruited a total of 560 patients, 280 in group M and 280 in group A. Compared to Group M, Group A exhibited a significantly higher incidence of ED ( < 0.001), elevated CAPD scores ( < 0.001), and prolonged PACU stays ( < 0.001). Notably, there was no significant difference in extubation time and anesthesia-related adverse events or other postoperative complications between the groups.
Our study highlights that the time of surgery significantly affects the incidence of ED, CAPD scores, and PACU stay duration in children. Further validation of these findings may guide future strategies to reduce ED.
苏醒期谵妄（ED）是一个广为人知的问题，它会延长机械通气时间和麻醉后护理单元（PACU）复苏时间，从而增加医院成本和死亡率。昼夜节律的术后紊乱通常会导致睡眠障碍，已被确定为ED的一个重要危险因素。然而，手术时间（上午与下午）对接受全身麻醉的儿科患者ED发生率的影响仍不清楚。
将年龄在2至6岁、全身麻醉下双谱指数值在50至60之间接受手术的患者，根据麻醉开始时间分为上午手术组（M组，8:00 - 12:00）或下午手术组（A组，13:00 - 17:00）。主要结局是通过康奈尔儿科谵妄评估（CAPD）评分评估的拔管后ED发生率。次要结局包括拔管时间、PACU停留时间以及术后不良事件和并发症。
我们共招募了560例患者，M组280例，A组280例。与M组相比，A组的ED发生率显著更高（<0.001），CAPD评分升高（<0.001），PACU停留时间延长（<0.001）。值得注意的是，两组之间的拔管时间以及与麻醉相关的不良事件或其他术后并发症没有显著差异。
我们的研究强调，手术时间显著影响儿童的ED发生率、CAPD评分和PACU停留时间。对这些发现的进一步验证可能会为未来减少ED的策略提供指导。
