七氟醚与地氟醚麻醉对成人骨科患者苏醒期躁动影响的比较

目的比较七氟醚与地氟醚对成人骨科手术患者苏醒期躁动(emergence agitation, EA)的影响。方法择期实施骨科手术的患者120例,男79例,女41例,年龄18～60岁,BMI 19.2～23.8 kg/m~2,ASAⅠ或Ⅱ级。患者依据随机原则分为七氟醚组(S组)和地氟醚组(D组),每组60例。在拔管前按照改良小儿苏醒期烦躁量表(PAED)评估EA程度,术后按照数字评价量表(nmeric rating scales, NRS)对患者术后疼痛程度进行评分,并观察分析舒芬太尼总量、手术时间、麻醉时间、苏醒时间、拔管时间和术后寒战、恶心呕吐等不良反应发生情况。记录两组患者强行体动、切口裂开、出血增多、自行拔除导管等严重不良反应发生情况。结果两组患者性别、年龄、身高、体重、BMI、ASA分级和手术种类等差异无统计学意义,两组患者舒芬太尼总量、手术时间、麻醉时间差异无统计学意义。D组患者改良PAED评分明显高于S组(P0.05),苏醒时间明显短于S组(P0.05),两组患者入恢复室15 min NRS评分、拔管时间、寒战、恶心呕吐等差异无统计学意义。两组患者均未出现强行体动、切口裂开、出血增多、自行拔除导管等严重不良反应。结论地氟醚麻醉的成人骨科患者术后尽管从全身麻醉中苏醒更快,但苏醒期躁动发生程度较七氟醚麻醉更为严重。在地氟醚麻醉中认识到苏醒期躁动的风险性并预防重大并发症是非常重要的。     

小儿七氟醚麻醉苏醒期间躁动的研究

目的 观察小儿七氟醚麻醉苏醒期在不同年龄和不同麻醉时的躁动情况.方法 选择学龄前儿童(3～5岁)及学龄儿童(6～9岁)各60例拟进行双侧扁桃体摘除术和腹股沟斜疝修补术患儿,分别均分为学龄前儿童静-吸复合组(A1组)及七氟醚吸入组(A2组),学龄儿童静-吸复合组(B1组)及七氟醚吸入组(B2组).A1、B1纽静-吸复合麻醉诱导采用静注咪唑安定0.1 mg/kg、丙泊酚2 mg/kg、芬太尼2 μg/kg;A2、B2组吸入麻醉诱导采用8%七氟醚吸入.维持吸人3%～5%七氟醚,调节氧浓度1～2 L/min,将肺泡最低有效浓度值控制在1.3～1.5 MAC.术毕记录手术时间、拔管时间(停药至拔除气管导管的时间)和苏醒时间(停药至呼之睁眼的时间),并记录躁动发生情况.结果 同一年龄不同麻醉方式组患儿:术后轻、中、重度躁动发生率A2组明显高于A1组、B2组明显高于B1组(P<0.05).不同年龄同一麻醉方式组的患儿:术后轻、中度躁动发生率A1组明显高于B1组、A2组明显高于B2组(P<0.05);而重度躁动发生率A2组明显高于B2组(P<0.05)(表1).结论 学龄前儿童及吸入麻醉苏醒期躁动发生率高.     

术前口服咪达唑仑对患儿七氟醚麻醉苏醒期躁动的影响

目的评价术前口服咪达唑仑对患儿七氟醚麻醉苏醒期躁动的影响。方法选择择期七氟醚麻醉下行扁桃体/腺样体切除术的患儿60例,男34例,女26例,年龄2~7岁,ASAⅠ或Ⅱ级,将入选患儿随机分为低剂量咪达唑仑组(M1组)、高剂量咪达唑仑组(M2组)和对照组(C组),每组20例。麻醉前30min分别给予M1组和M2组患儿分别口服咪达唑仑0.5 mg/kg和0.75 mg/kg,口服10%葡萄糖混合液5ml。吸入8%七氟醚行麻醉诱导,术中吸入七氟醚及静脉泵注瑞芬太尼维持麻醉。记录患儿分离焦虑量表(PSAS)评分、麻醉苏醒谵妄量表(PAED)评分和FLACC疼痛评分,并记录拔除气管导管时间和滞留PACU时间。结果 C组患儿的分离焦虑发生率明显高于其他两组(P0.05)。三组苏醒期躁动发生率、最高PAED评分、FLACC疼痛评分以及拔除气管导管时间差异均无统计学意义。M2组滞留PACU时间明显长于其他两组(P0.05)。结论术前口服咪达唑仑0.5mg/kg或0.75mg/kg能有效减轻患儿术前分离焦虑,但不能减少七氟醚麻醉苏醒期躁动的发生,咪达唑仑0.75mg/kg会延长PACU滞留时间。     

芬太尼滴鼻对患儿鼻罩吸入七氟醚麻醉苏醒期谵妄的影响

目的探讨芬太尼滴鼻对患儿鼻罩吸入七氟醚麻醉苏醒期谵妄的影响。方法选择全麻下行舌系带延长术患儿40例,男17例,女23例,ASAⅠ级,年龄2~4岁。随机均分为研究组和对照组。入室后面罩吸入8%七氟醚+氧气进行麻醉诱导,研究组患儿无意识后鼻腔滴入芬太尼2μg/kg,稀释成0.5ml,对照组患儿安静后鼻腔滴入生理盐水0.5ml,两组患儿手术开始前舌系带旁局部浸润注射1%利多卡因2ml。术中鼻罩吸入3%~5%七氟醚+氧气维持麻醉。患儿入手术室前根据改良耶鲁术前焦虑分级表(m-YPAS)评分,诱导期间根据诱导期合作度量表(ICC)对患儿面罩吸入七氟醚诱导期间合作程度评分,术后根据小儿麻醉苏醒期谵妄量表(PAED)及改良加拿大东安大略儿童医院疼痛评分量表(m-CHEOPS),对患儿苏醒期谵妄、疼痛情况进行评分。结果两组患儿术前m-YPAS评分、诱导期ICC评分及术后m-CHEOPS评分差异均无统计学意义。研究组术后PAED评分为(4.8±2.5)分,明显低于对照组的(7.7±4.2)分(P<0.05)。两组患儿围术期生命体征平稳,均未出现严重低血压、低氧血症、心动过缓、呼吸抑制、严重的恶心、呕吐等麻醉相关并发症。两组PACU滞留时间差异无统计学意义。结论芬太尼滴鼻能有效减少患儿鼻罩吸入七氟醚麻醉下行舌系带延长术苏醒期谵妄的发生,且不延长PACU滞留时间。     

右美托咪定预防七氟醚麻醉患儿苏醒期躁动的效果

目的观察右美托咪定预防七氟醚麻醉患儿苏醒期躁动的效果。方法随机将86例行七氟醚麻醉的患儿分为2组,各43例。观察组在麻醉诱导后行右美托咪定液0.5μg/kg静脉泵注,15 min注完。对照组在麻醉诱导后静脉泵注等容量的生理盐水。比较2组注射后5 min(T_1)、苏醒睁眼时(T_2)及拔管后5 min(T_3)患儿的心率(HR)、平均动脉血压(MAP)变化。根据麻醉苏醒期躁动量化评分量表(PAED)比较2组麻醉苏醒期的躁动情况。结果 2组患儿各时点的MAP和HR比较,差异无统计学意义(P0.05);观察组患儿苏醒期躁动发生率及PAED评分均低于对照组,差异有统计学意义(P0.05)。结论麻醉诱导后静脉泵注右美托咪定,可有效预防七氟醚麻醉患儿苏醒期躁动发生情况,而且能维持血流动力学平稳。     

右美托咪啶预防儿童七氟醚麻醉苏醒期躁动效果的观察

目的观察应用右美托咪啶预防儿童七氟醚麻醉苏醒期躁动的效果。方法将56例接受七氟醚麻醉手术的患儿随机分为2组,每组28例。观察组:麻醉诱导后静脉泵注右美托咪定注射液0.5μg/kg(稀释到15 m L),10~20 min注完后开始手术。对照组:麻醉诱导后手术开始前泵注15 m L生理盐水。比较2组患儿右美托咪啶或生理盐水注射前(T0)、注射5 min后(T1)、患儿苏醒睁眼时间点(T2)及拔管5 min后(T3)心率、血压变化和麻醉后的苏醒时间、躁动情况等。结果对照组T2和T3时点的NAP和HR较T0明显升高,差异有统计学意义(P0.05);与对照组比较,观察组T2和T3时间点MAP明显降低,同时T1、T2和T3时间点HR明显降低,差异均有统计学意义(P0.05)。观察组患儿苏醒期躁动发生率低于对照组,苏醒时间长于于对照组,2组比较差异具有统计学意义(P0.05)。结论麻醉诱导后手术开始前应用右美托咪啶,在儿童七氟醚麻醉时能较好维持血流动力学的平稳,降低苏醒期的躁动发生率。     

蘸糖安抚奶嘴减轻患儿七氟醚全麻苏醒期躁动

<正>全身麻醉苏醒期躁动是指患儿在全麻苏醒期出现的一种意识与行为紊乱的状态,表现为哭闹、激动、无法安抚等,多发生在拔管后15 min内,特别是在以七氟醚麻醉为主的吸入全麻中发生率最高,可达80%[1],在1岁以内患儿的发生率虽然略低,约为35%[2],但是可能造成严重后果,如意外拔出引流管、肢体不自主运动造成手术部位伤口出血及留置针脱出等。有研究指出[3],安慰奶嘴可以对急诊患儿起到     

丙泊酚联合七氟烷麻醉对全麻下扁桃体切除术患儿苏醒期躁动的影响

目的观察丙泊酚联合七氟烷麻醉对全麻下扁桃体切除术患儿苏醒期躁动的影响。方法随机将行扁桃体切除术的94例患儿分为2组,各47例。对照组实施七氟烷麻醉,观察组采取丙泊酚联合七氟烷麻醉。观察2组麻醉苏醒时间、手术时间、不良反应、苏醒期躁动发生情况等。结果 (1)观察组Watcha评分、苏醒期躁动发生率低于对照组,差异有统计学意义(P0.05)。(2)2组麻醉苏醒时间、手术时间、不良反应发生率差异无统计学意义(P0.05)。结论丙泊酚联合七氟烷麻醉有助于提升全麻下扁桃体切除术患儿镇静效果,减少苏醒期躁动发生率,安全性较高。     

小儿七氟醚麻醉后躁动的研究进展

背景 七氟醚因其具有无刺激味、诱导迅速及对呼吸循环影响小等特点,目前广泛应用于小儿全身麻醉的诱导和维持.但小儿七氟醚麻醉后躁动发生率远高于成年人,对术后管理非常不利. 目的 提高小儿七氟醚全身麻醉苏醒的质量. 内容 系统回顾近年来小儿七氟醚麻醉后躁动的研究,综述其可能的发病机制及防治措施. 趋向 七氟醚麻醉后躁动的发生机制尚不清楚,特别是基础研究还需深入.     

地氟醚、七氟醚和异氟醚对犬冠脉血流的影响

目的：采用超声血流量监测仪观察地氟醚、七氟醚和异氟醚对犬冠脉血流的影响。方法：犬１８只，腹腔注射１．５％硫喷妥钠２０ｍｇ／ｋｇ，静脉注射阿曲库铵０．８ｍｇ／ｋｇ麻醉诱导，气管插管后取正中开胸，分离冠状动脉左前降支，将３ｍｍ或３．５ｍｍ超声Ｄｏｐｐｌｅｒ血管探头置于分离血管处，连接超声多普勒冠脉血流量监测仪测定冠脉血流量，然后随机吸入地氟醚、七氟醚或异氟醚，ＭＡＣ分别为７．２％、２．３％和１．２８％     

Incidência de delírio ao despertar e fatores de risco após o uso de sevoflurano em pacientes pediátricos para cirurgia ambulatorial,Kingston, Jamaica

Background and objectivesEmergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica.MethodsThis was a cross‐sectional, observational study including pediatric patients aged 3–10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day‐case procedures. Data collected included patients’ level of anxiety pre‐operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non‐purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post‐operative complications related to emergence delirium episodes were also noted.Results145 children were included, with emergence delirium occurring in 28 (19.3%). Emergence delirium episodes had a mean duration of 6.9 ± 7.8 min, required pharmacologic intervention in 19 (67.8%) children and were associated with a prolonged recovery time (49.4 ± 11.9 versus 29.7 ± 10.8 min for non‐agitated children; p < 0.001). Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2–8.6) and moderate and severe anxiety prior to induction (p < 0.001, OR 5.6, 95% CI 2.3–13.0). Complications of emergence delirium included intravenous line removal (n = 1), and surgical site bleeding (n = 3).ConclusionChildren of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.     

The effect of nebulized lidocaine hydrochloride on emergence from sevoflurane anesthesia in children undergoing Tonsillectomy

BackgroundSevoflurane-related emergence agitation (EA) is considered a significant problem that interferes with children’s recovery; our aim was to evaluate the efficacy of nebulized lidocaine hydrochloride when given before sevoflurane anesthesia in attenuating EA in children undergoing tonsillectomy.Materials and methodsA randomized clinical study was conducted on eighty children ASA I and II who underwent tonsillectomy. The children were randomized to one of two groups according to the nebulizer contents. Lidocaine group (group L) received nebulized solution of 4 mg/kg lidocaine hydrochloride and placebo group (group P) received nebulized solution contains 0.9% normal saline.ResultsThe number of agitated patients were significantly lowered in the lidocaine group compared to the placebo group; p value (0.012).ConclusionThe use of nebulized lidocaine before sevoflurane anesthesia for pediatric patients undergoing tonsillectomy attenuated the sevoflurane-related EA with no side effects.     

Propofol reduces the incidence of emergence agitation in preschool-aged children as well as in school-aged children: a comparison with sevoflurane

Purpose Young age is considered as one of the factors associated with emergence agitation (EA) following sevoflurane anesthesia. The relationship between EA following propofol anesthesia and young age has not yet been examined. This study was designed to compare the incidence of EA in younger children and older children following either propofol or sevoflurane anesthesia. Methods Ninety-six preschool-aged (2–5 years) children and 90 school-aged (6–11 years) children (American Society of Anesthesiologists [ASA] I or II) scheduled to undergo otorhinolaryngological surgery were randomly assigned to receive either propofol or sevoflurane. These children were divided into the following four groups: propofol-preschool (P-pre), sevoflurane-preschool (S-pre), propofol-school (P-school), and sevoflurane-school (S-school) groups. Recovery times and incidence of EA were compared among the four groups. Results We observed that the recovery times were similar in the four groups. After extubation, the incidence of EA in the S-pre group was significantly higher than that in the other groups. After eye opening, the incidence of EA in the S-pre and S-school groups was significantly higher than that in the P-pre or P-school groups. At all recovery times, no difference was observed in the incidence of EA between the P-pre and P-school groups. Conclusion Propofol, in comparison with sevoflurane, resulted in a lower incidence of EA, with no relation to age.     

曲马多不同静脉给药方案对小儿扁桃体切除术后躁动的影响

目的观察曲马多不同静脉给药方案对小儿扁桃体切除术后躁动的影响。方法择期扁桃体切除术患儿240例,年龄3~6岁,采用随机数字表法分为六组:A组诱导时给予曲马多2mg/kg,手术结束时给予生理盐水;B组诱导时给予生理盐水,手术结束时给予曲马多2mg/kg;C组诱导时给予曲马多1mg/kg,手术结束时给予生理盐水;D组诱导时给予生理盐水,手术结束时给予曲马多1mg/kg;E组诱导时给予曲马多1mg/kg,手术结束时给予曲马多1mg/kg;F组诱导时与手术结束时均给予生理盐水。记录拔管时间,清醒时间,清醒后10、20、30、40、50、60min的Ramsay镇静评分、躁动评分、FLACC评分及恶心呕吐发生率。结果清醒后10~50min B组镇静躁动评分、FLACC评分均明显低于其他五组(P0.05),而F组明显高于其他五组(P0.05)。清醒后10~40min B组Ramsay镇静评分明显高于其他五组(P0.05)。结论曲马多在小儿扁桃体切除术结束时以2mg/kg静脉注射可以在手术后1h内提供较好的镇静与镇痛,不增加手术后恶心呕吐的发生率,不影响拔管时间与清醒时间。     

丙泊酚和七氟烷对小儿骨科手术苏醒期躁动的影响

目的 观察丙泊酚和七氟烷在神经阻滞复合喉罩全身麻醉的小儿骨科手术中,对小儿术后苏醒期躁动的影响。方法 选择本院小儿骨科手术患儿80例,随机分成丙泊酚组和七氟烷组。患儿采用改良耶鲁术前焦虑量表（the modified Yale Preoperative Anxiety Scale, m-YPAS）评估后入手术室,常规静脉诱导后置入喉罩机械通气,采用不同的麻醉药物进行维持,随后局麻下行超声引导神经阻滞。所有患儿在恢复自主呼吸后氧饱和度均维持在95%以上,拔除喉罩送至苏醒室。观察比较两组患儿苏醒时的拔管时间、小儿麻醉苏醒期躁动量化评分表（pediatric anesthesia emergence delirium scale, PAED）评分及儿童疼痛行为量表（The face, legs, activity, cry, consolability behavioral tool, FLACC）评分和Richmond躁动-镇静量表（Richmond agitation and sedation scale, RASS）评分。结果 丙泊酚组和七氟烷组患儿的m-YPAS评分分别为（26.94±11.07）分、（26.10±8.22）分,差异无统计学意义（P=0.699）。丙泊酚组拔管时间明显长于七氟烷组［（9.95±5.27） min vs. （5.30±2.94） min］,急性躁动PAED评分明显低于七氟烷组［（7.15±2.30）分 vs. （9.50±2.44）分］,苏醒期躁动发生率明显低于七氟烷组（5% vs. 15%）,上述指标比较,差异均有统计学意义（P均＜0.001）。躁动患儿的FLACC评分为3~8分,RASS评分为-3~-2分,处于轻度至中度镇静状态。结论 小儿骨科手术神经阻滞复合喉罩全身麻醉术后苏醒躁动仍有发生;丙泊酚维持麻醉术后躁动发生率较七氟烷低,患儿舒适安全,值得临床推广。     

右美托咪定对slJL扁桃体和／或腺样体术后躁动的影响

目的观察小剂量右美托咪定（dexmedetomidine,Dex）对小儿七氟烷全麻扁桃体和／或腺样体术后苏醒期躁动的影响。方法选取年龄2岁～8岁,美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级,拟在七氟烷吸入麻醉下进行扁桃体和／或腺样体摘除的患儿90名,采用双盲法以抽签形式将患者随机分为两组（每组45例）：实验组（D组）和对照组（s组）。D组在诱导时给予Dex负荷量0.3μg／kg（10min泵人）,后以0．2μg·kg-1·h-1维持;S组给予等容生理盐水,两组麻醉均以七氟烷维持,记录患者心率（heart rate,HR）、血压、脉搏血氧饱和度、呼气末七氟烷浓度、停药到自主呼吸恢复时间、停药至拔管时间、拔管后躁动评分。结果D组苏醒期躁动发生率为28.89％,S组为64.44％,且每个时间记录点D组发生躁动的人数均少于S组。结论小剂量Dex能减轻小儿七氟烷全麻扁桃体和／或腺样体术后苏醒期躁动。     

右美托咪定复合氟哌利多对七氟醚全麻胸科手术老年患者苏醒期躁动的影响

目的评价右美托咪定复合氟哌利多治疗七氟醚全麻胸科手术老年患者苏醒期躁动的有效性及安全性。方法选取七氟醚全麻下普胸外科术后严重躁动老年患者60例,男48例,女12例,年龄66～75岁,ASAⅡ或Ⅲ级,按照随机数字表分为三组:氟哌利多组(F组)、右美托咪定组(D组)和右美托咪定复合氟哌利多组(DF组)。被诊断为苏醒期严重躁动后,F组静脉推注氟哌利多0.06 mg/kg;D组右美托咪定1μg/kg泵注10 min,继以0.2μg·kg~(-1)·h~(-1)维持泵注1 h;DF组静脉推注氟哌利多0.03 mg/kg,同时给予右美托咪定0.5μg/kg泵注10 min,继以0.2μg·kg~(-1)·h~(-1)维持泵注1 h。观察并记录躁动评分、Ramsay镇静评分、PaCO_2变化以及恶心、呕吐等不良反应的发生情况。结果给药后5、10、15、20 min DF组躁动评分明显低于D组(P0.05);给药后60、90、120 min DF组躁动评分明显低于F组(P0.05)。给药后60、120 min三组PaCO_2差异无统计学意义。DF组和D组过度镇静比例明显低于F组(P0.05)。三组恶心、呕吐、心动过缓、高血压、低血压发生率差异无统计学意义。结论右美托咪定复合氟哌利多用于老年患者七氟醚全身麻醉苏醒期躁动的治疗效果确切,安全性好,可以规避右美托咪定不能快速推注同时避免氟哌利多导致过度镇静的缺点。