Tuncer Bilge, Çelik Fulya, Çelik Burak, Erkılıç Ezgi
Department of Anesthesiology and Reanimation, Ankara Bilkent City Hospital, Ankara 06800, Turkey.
Department of Anesthesiology and Reanimation, Ankara Etlik City Hospital, Ankara 06010, Turkey.
J Clin Med. 2024 Dec 11;13(24):7532. doi: 10.3390/jcm13247532.
Postoperative delirium is a frequent complication in children undergoing general anesthesia. It has been suggested that inflammation and oxidative stress contribute to the pathophysiology of delirium. The aim of our study was to investigate the relationship between inflammatory markers and delirium. A total of 221 children in the ASA 1-3 risk group who underwent adenoidectomy, tonsillectomy, and/or ventilation tube application were included in our single-center, prospective, and observational study approved by the Ethics Committee, numbered E1-23-3197. Patients whose parental consent was obtained were either premedicated with oral midazolam preoperatively or taken to surgery without premedication, depending on the anesthesiologist's preference. After induction with sevoflurane, rocuronium and fentanyl were administered intravenously. Sevoflurane and infusion of remifentanil were administered for maintenance. At the end of the operation, patients were transferred to the recovery unit and followed up for 30 min. They were evaluated with the Face, Legs, Activity, Cry, and Consolability (FLACC) Scale and Pediatric Anesthesia Emergence Delirium (PAED) Scale. Delirium was observed in 80 patients. There was no significant difference between patients with and without delirium in terms of neutrophil/lymphocyte ratio, mean platelet volume, or platelet distribution volume. Lymphocyte count, PAED score, and FLACC score were statistically higher in patients with delirium (W = 4407.5, -value = 0.006997; W = 0, -value < 2.2 × 10; W = 9489, -value < 2.2 × 10, respectively). No statistically significant relationship was found between hematologic inflammatory markers and delirium. Controlled studies with larger sample sizes are needed to determine whether these markers have strong predictive value.
术后谵妄是接受全身麻醉的儿童中常见的并发症。有人提出炎症和氧化应激参与了谵妄的病理生理过程。我们研究的目的是调查炎症标志物与谵妄之间的关系。本单中心、前瞻性、观察性研究纳入了221例ASA 1-3风险组且接受腺样体切除术、扁桃体切除术和/或置管通气的儿童，该研究经伦理委员会批准，编号为E1-23-3197。获得家长同意的患者，根据麻醉医生的偏好，术前要么口服咪达唑仑进行术前用药，要么不进行术前用药直接接受手术。用七氟醚诱导后，静脉注射罗库溴铵和芬太尼。维持麻醉时使用七氟醚并输注瑞芬太尼。手术结束时，患者被转至恢复室并随访30分钟。使用面部、腿部、活动、哭闹和可安慰性（FLACC）量表及小儿麻醉苏醒期谵妄（PAED）量表对患者进行评估。80例患者出现了谵妄。在中性粒细胞/淋巴细胞比值、平均血小板体积或血小板分布宽度方面，出现谵妄和未出现谵妄的患者之间无显著差异。出现谵妄的患者淋巴细胞计数、PAED评分和FLACC评分在统计学上更高（分别为W = 4407.5，P值 = 0.006997；W = 0，P值 < 2.2×10⁻¹⁶；W = 9489，P值 < 2.2×10⁻¹⁶）。未发现血液学炎症标志物与谵妄之间存在统计学上的显著关系。需要进行更大样本量的对照研究来确定这些标志物是否具有较强的预测价值。
