全身麻醉术后苏醒延迟临床分析

目的探讨全身麻醉(全麻)术后苏醒延迟的原因及防治措施。方法对36例全麻术后苏醒延迟患者的手术、麻醉资料进行回顾行分析,为改善全麻效果提供依据。结果 36例全麻术后苏醒延迟的主要原因有:(1)麻醉药物使用相对过量。(2)机体代谢紊乱。(3)患者体温过低。(4)术前有效睡眠时间不足。结论全麻术后苏醒延迟可由多种原因引起。做好麻醉前会诊及准备,在全麻手术过程中,加强麻醉管理,监测血压、呼吸、体温、血气、血糖、肌肉松弛度以及个体化使用麻醉药,有助于减少或者避免苏醒延迟的发生。     

觉醒神经通路参与全身麻醉苏醒的研究进展

背景 大量的研究表明全身麻醉苏醒与觉醒有着相同的中枢神经通路,即在觉醒期表现活跃的脑区、大脑皮质及相关脑区增多的神经递质与全身麻醉苏醒期有着一致改变. 目的 总结分析上行觉醒神经系统在全身麻醉苏醒中的作用,为全身麻醉药物苏醒机制的进一步研究提供新的思路. 内容 主要从全身麻醉苏醒的简介、上行觉醒神经通路、觉醒神经通路参与全身麻醉苏醒等三方面就与此相关的研究进展作一系统的综述. 趋向 上行觉醒系统在全身麻醉苏醒机制中的关键作用将会被进一步关注与深入研究,为解决苏醒延迟导致的术后谵妄或术后认知功能障碍等问题提供新的线索.     

全身麻醉术后患者苏醒期并发症发生情况调查分析

目的了解全麻术后患者苏醒期并发症发生情况,为临床监护及制定个体化护理方案提供参考。方法将2 938例全麻术后入麻醉恢复室患者按年龄段分为儿童组(285例)、青年组(816例)、中年组(1 432例)及老年组(405例),观察、记录并发症发生情况。结果全麻术后苏醒期567例(19.30%)患者发生并发症;四组高血压、低血压、低氧血症、躁动、苏醒延迟发生率比较,差异有统计学意义(均P0.01);苏醒时间老年组最长、儿童组最短(均P0.05)。结论患者全麻术后苏醒期并发症发生率较高,老年组以高血压、低氧血症、苏醒延迟发生率偏高,青年组以低血压发生率偏高,儿童组以躁动发生率偏高。应根据患者年龄与并发症特点采取相应护理措施,确保患者安全复苏。     

全麻恢复期并发症及其处理

全身麻醉后由于麻醉药物的影响、手术的直接创伤以及病人原有病理生理的变化等 ,均可导致某些并发症的发生。手术结束后 ,麻醉作用并未完全消失 ,即使病人已经清醒 ,药物作用却未必完全消除 ,保护性反射也没有恢复正常 ,此时仍有可能发生各种并发症。如何积极防治全麻恢复期并发症的发生 ,也是麻醉医师一项至关重要的任务。苏醒延迟全身麻醉后超过预期苏醒的时间仍未苏醒者 ,称苏醒延迟。采用现代麻醉方法 ,多数病人能在手术后不久即可清醒。如全麻后超过 2ｈ意识仍不恢复 ,即可认为麻醉苏醒延迟 ,应立即查明原因 ,及时处理 ,以防意外。一、…     

中西医防治全身麻醉术后苏醒延迟的研究进展

全身麻醉术后苏醒延迟严重影响患者术后转运及恢复质量，其机制和相关风险尚未明确，因此缺少确切、有效的综合预防与处理措施。目前临床多以术前充分准备、优化麻醉方案、重视器官功能保护以及体温与容量调控作为主要预防手段；在苏醒期及时评估、预判和预处理，并在对症、支持治疗的基础上使用拮抗与催醒药物是苏醒延迟的主要处理手段。此外，针刺、穴位刺激及中药制剂在围术期的应用极大地丰富了苏醒延迟的预防与处理手段。本文对近年来中西医预防与处理苏醒延迟的研究进行综述，以期探索中西医结合改善全身麻醉患者苏醒质量、预防与处理苏醒延迟的新思路和新方法。     

充气式保温毯用于麻醉复苏室全麻恢复期患者的效果观察

目的评价充气式保温毯在麻醉复苏室预防全麻患者恢复期低体温及寒颤的效果。方法将80例择期全麻手术患者随机分为观察组和对照组各40例。对照组入麻醉恢复室后给予常规太空被保暖;观察组使用充气式保温毯保暖。评价两组患者体温变化及寒颤、苏醒延迟发生率。结果观察组低体温及苏醒延迟率显著低于对照组,入麻醉复苏室30 min、出室时体温显著高于对照组(P0.05,P0.01)。结论应用充气式保温毯能有效降低全麻恢复期患者低体温,促进患者麻醉后苏醒。     

妇科微创术后复苏患者苏醒时间影响因素分析

目的 探讨妇科微创术后复苏患者麻醉苏醒时间及影响因素,为缩短术后苏醒时间、加快手术相关床位周转提供参考。方法 回顾性收集2019年2 526例妇科微创手术患者资料,统计麻醉复苏室苏醒时间并分析影响因素。结果 妇科微创手术患者苏醒时间3~220 min;低体温、麻醉时间、镇静药使用、入麻醉复苏室平均动脉压及恶性肿瘤是麻醉苏醒时间的影响因素(P<0.05,P<0.01)。结论 妇科微创术后患者苏醒时间受多种因素影响,复苏期护理应针对影响因素采取多项措施综合干预,以缩短苏醒时间、提高苏醒质量、提高手术相关床位周转率。     

学龄儿童丙泊酚全凭静脉麻醉和七氟醚吸入麻醉与静吸复合麻醉的比较

观察学龄儿童丙泊酚全凭静脉麻醉、七氟醚吸入麻醉与静吸复合麻醉围麻醉期血流动力学、脑电参数的变化,比较术中情况及术后苏醒过程,为学龄儿童临床全麻的应用提供参考.     

臂旁核神经通路在全身麻醉致意识改变中作用的研究进展

全身麻醉药(以下简称全麻药)的主要药理效应包括:可逆性的意识消失、镇痛、遗忘以及肌松作用, 其中意识消失是其最具特征性的表现。迄今为止, 全麻药通过何种机制介导意识消失与恢复仍不明确。近年来, 多项研究从神经网络调控理论出发以期阐明全身麻醉的调控靶点, 发现蓝斑核[1]、伏隔核[2]、中缝背核[3]、外侧下丘脑[4]等核团均参与全身麻醉的过程, 运用光遗传学、化学遗传学等方法调控核团内特定类型的神经元会影响麻醉诱导时间和麻醉苏醒时间, 并伴有皮层脑电的同步变化。然而, 全身麻醉下通过兴奋或抑制某单个核团, 并不能呈现完整的意识变化, 提示全身麻醉致意识改变可能是神经通路共同参与调控的结果。因此, 探索全麻药对不同神经通路的具体作用可能有助于解开全身麻醉药致意识改变的作用机制。     

不同通气方式下急性上消化道出血胃镜诊治的比较

正急性上消化道出血是临床常见急症,早期诊断和治疗关系着抢救的成败。快速出血导致休克甚至误吸[1],苏醒期各种并发症及苏醒延迟影响术后恢复。因此,急诊胃镜辅助诊疗的麻醉选择应力求循环稳定、呼吸道通畅,同时苏醒迅速平稳。本研究通过比较自主呼吸下静脉全麻与气管插管全麻辅助急诊胃镜诊疗过程中患者循环与呼吸参数的改变以及苏醒期并发症的发生及苏醒时间的影响因素,为临床救治上消化道急性出血患者提供参考。     

Mechanisms of anesthetic actions and the brain

The neural mechanisms behind anesthetic-induced behavioral changes such as loss of consciousness, amnesia, and analgesia, are insufficiently understood, though general anesthesia has been of tremendous importance for the development of medicine. In this review, I summarize what is currently known about general anesthetic actions at different organizational levels and discuss current and future research, using systems neuroscience approaches such as functional neuroimaging and quantitative electrophysiology to understand anesthesia actions at the integrated brain level.     

Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double-blind, randomized trial

Background:  Pediatric dental procedures are increasingly performed under general anesthesia because of the inability to cooperate, situational anxiety, or other behavioral problems. Volatile anesthetics have been associated with emergence delirium in children, whereas the use of propofol for anesthetic maintenance has been shown to reduce the incidence of emergence delirium after other types of surgeries. The aim of this study is to compare a sevoflurane-based anesthetic with a propofol-based technique as it relates to the incidence of emergence delirium and the quality of recovery after pediatric dental surgery, in patients who present with risk factors for perioperative behavioral issues.
Methods:  We prospectively collected data of 179 pediatric patients scheduled for ambulatory dental surgery using a double-blind and randomized trial design. Subjects were anesthetized following standardized protocols for either a sevoflurane- or a propofol-based technique. The incidence of emergency delirium, as measured by the Pediatric Anesthesia Emergence Delirium score, was the primary outcome. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), number of nursing interventions in the recovery room, time to discharge readiness, and parental satisfaction.
Results:  We found no difference in the incidence of emergence delirium after both types of anesthesia. However, use of sevoflurane significantly increased both the risk of PONV and the number of postoperative nursing interventions. Discharge criteria were met about 10 min earlier in patients anesthetized with sevoflurane. Parental satisfaction was equally high with both anesthesia regimens.
Conclusions:  A propofol-based anesthetic technique did not lead to a lower incidence of emergence delirium after dental surgery in children but did result in significantly less PONV and fewer postoperative nursing interventions.     

丙泊酚诱导意识消失的脑电机制

脑电图可以实时连续地记录大脑区域内局部神经元自发的、有节律的电活动,评价大脑功能状态,是一种监测大脑活动的工具,广泛应用于心理学、认知功能以及意识状态等研究领域,为研究全麻药物的作用机制提供了一种新方法。丙泊酚在临床上应用广泛,分子机制已得到深入研究。丙泊酚诱导意识消失的神经脑网络机制目前尚未明确。本文回顾了常用全麻药物丙泊酚诱导意识消失的脑电特征性改变（包括功率谱、复杂度、微状态、功能连通性及脑网络拓扑特征改变）及相应的大脑功能变化,为进一步研究全麻药物的作用机制以及麻醉深度监测提供新思路。     

Acupuncture management of pain and emergence agitation in children after bilateral myringotomy and tympanostomy tube insertion

Aim:  To further investigate the effect of acupuncture in postoperative pain and emergence agitation in children undergoing bilateral myringotomy and tympanostomy tube (BMT) placement.
Background:  BMT insertion surgery in children is routinely performed under general anesthesia and is associated with a high incidence of postoperative pain and agitation upon emergence from anesthesia. Various medications have been investigated to alleviate the pain and agitation, which have been accompanied by high incidence of adverse effects. In children, anecdotal reports suggest that acupuncture may offer postoperative analgesia.
Methods/Materials:  This prospective randomized controlled trial is to evaluate the effectiveness of acupuncture to control pain and agitation after initial bilateral myringotomy tube placement in 60 nonpremedicated children. Acupuncture was applied at points LI-4 (he gu) and HT-7 (shen men) immediately after induction of anesthesia. A single-blinded assessor evaluated postoperative pain and agitation using CHEOPS and emergence agitation scale. Pain and agitation scores were significantly lower in the acupuncture group compared to those in the control group at the time of arrival in the post anesthesia care unit and during the subsequent 30 min.
Results:  Acupuncture treatment provided significant benefit in pain and agitation reduction. The median time to first postoperative analgesic (acetaminophen) administration was significantly shorter in the control group. The number of patients who required analgesia was considerably fewer in the acupuncture group than that in the control. No adverse effects related to acupuncture treatment were observed.
Conclusion:  Our study suggests that acupuncture therapy may be effective in diminishing both pain and emergence agitation in children after BMT insertion without adverse effects.     

Dissociative amnesia after general anesthesia--a case report

Psychogenic unconsciousness is a rare cause of failure of prompt recovery from general anesthesia. The diagnosis is only made by exclusion of other conditions. We describe a young, healthy female who failed to wake up promptly after total intravenous anesthesia with alfentanil and propofol. She regained consciousness 24 hours later without any specific treatment. However she sustained amnesia for a period of 48 hours. Dissociative disorder was diagnosed after an extensive workup. This case report emphasizes the importance of inclusion of psychiatric disorder in the differential diagnosis should unexplainable delayed emergence from general anesthesia occur.     

A case of delayed emergence from anesthesia caused by postoperative brain edema associated with unexpected cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis (CVST) is rare but displays various and often dramatic clinical symptoms. Few cases of CVST have been reported in the field of anesthesiology. We encountered an unexpected case of CVST that presented with delayed emergence from anesthesia after resection of a brain tumor. A 55-year-old man was scheduled for resection of an oligoastrocytoma in his right frontal lobe. After smooth induction of general anesthesia, anesthesia was maintained uneventfully for about 7 h with target-controlled infusion (TCI) of propofol and remifentanil, except for a seizure generated when the right anterior central gyrus was stimulated to allow motor evoked potential monitoring. Immediately after the cessation of TCI, spontaneous respiration was restored. However, the patient was unexpectedly comatose, and no response to painful stimuli or coughing during tracheal suctioning was observed. A computed tomogram taken 2 h after surgery showed diffuse brain edema, even though the neurosurgeons did not notice any cerebral swelling during closing of the dura mater. A magnetic resonance venogram revealed thromboses in the superior sagittal and straight sinuses. On the 9th postoperative day, the patient died without recovering consciousness or his brainstem reflexes. Anesthesiologists should be aware of CVST as a cause of delayed emergence from anesthesia after craniotomy.     

喉罩全麻白内障患儿手术苏醒期拔管时机的探讨

目的 降低惠儿全麻苏醒期喉罩拔出后呼吸道并发症的发生率,为患儿喉罩拔管时机的选择提供临床依据.方法 采用计算机随机将择期喉罩全麻下行白内障手术的患儿60例分为镇静状态喉罩拔管组(镇静组,33例)和清醒状态喉罩拔管组(清醒组,27例).在麻醉后恢复室观察并记录两组患儿拔出喉罩后呼吸道并发症发生率.结果 手术苏醒期,镇静组无一例发生呛咳,清醒组13例出现呛咳,两组比较,差异有统计学意义(P＜0.01).结论 患儿镇静状态下拔出喉罩能降低拔管后呛咳发生率,以保证患儿安全渡过全麻苏醒期.     

Clonidine for preventing emergence agitation in infants (PREVENT AGITATION II): Protocol and statistical analysis plan

Background

Emergence agitation is a common clinical condition in children. Symptoms pertaining to the spectrum of early postoperative negative behavior typically occur upon emergence from anesthesia. Clonidine is an effective adjunctive agent for the prevention of emergence agitation in children, but evidence in the smallest age groups is sparse We aim to investigate the efficacy and safety of an intraoperative bolus of intravenous clonidine for preventing emergence agitation in children 3–12 months of age.

Methods

This is a randomized, placebo-controlled, double-blind trial. We will enroll 320 patients aged 3–12 months who have been scheduled for general anesthesia maintained with sevoflurane and opioid. The randomization is parallel and stratified by age group, sex, and site. The investigational medicinal product will be administered intravenously ~20 min before the anticipated end of the surgical procedure. The intervention is clonidine 3 μg/kg and placebo is isotonic saline in a corresponding volume.

Results

The primary outcome is the incidence of emergence agitation as assessed on the Watcha scale, that is, any Watcha score >2 during participants' stay in the postanesthetic care unit. Secondary outcomes are the proportion of participants with postoperative pain, with postoperative nausea and vomiting, and a composite safety outcome. Statistical analysis will be conducted according to the Statistical Analysis Plan with the intention-to-treat population for our primary analyses.

Conclusion

The PREVENT AGITATION II trial will contribute valuable knowledge on efficacy for the prevention of emergence agitation and safety in infants.     

Pre-anesthetic maternal separation increases pups' locomotor behavior during emergence from anesthesia in rats

BACKGROUND: Problematic behavior at emergence from anesthesia in children, partly linked with maternal separation, is a major problem in pediatric anesthesia. In humans, as well as in many other mammalian species, such separation causes psychological and behavioral changes. This study was to investigate whether or not pre-anesthetic maternal separation has a similar effect on rat pups. METHODS: This study was conducted on 66 3-week-old Sprague-Dawley male rats. The rats were divided into two groups; pups housed with a dam (n = 33) and those housed without (n = 33). Pups were anesthetized with 1.2% halothane for 30 min. Afterwards we recorded their locomotor behavior at emergence from general anesthesia using a video tracking system. RESULTS: Pre-anesthetic maternal separation significantly increased the maximum velocity and the distance traveled by pups at the emergence. CONCLUSION: Pre-anesthetic maternal separation influenced pups' locomotive behavior at emergence.