Predictors of catheter-related bladder discomfort in the post-anaesthesia care unit
Predictors of catheter-related bladder discomfort in the post-anaesthesia care unit
复制标题
DOI：
10.1016/j.annfar.2010.12.009
复制
发表时间：
2011-02-01
影响因子：
--
通讯作者：
Marty, J.
中科院分区：
文献类型：
--
作者：
Binhas, M.;Motamed, C.;Marty, J.
背景- 导管相关性膀胱不适（CRBD）经常被报告为在麻醉后监护室（PACU）中对传统阿片类药物治疗有压力和抵抗力。诱导前1小时口服托特罗定或奥昔布宁或加巴喷丁可降低术后CRBD的发生率和严重程度。然而，这些药物可能会产生副作用。因此，这些不同药物的预给药应该是有选择性的中度或重度CRBD的预测因子的患者。本研究的目的是确定麻醉后监护室中术后早期CRBD的发生率和预测因素。- 我们在两家教学医院设计了一项前瞻性观察研究。在6个月的时间内，在全身麻醉下接受手术需要术中导尿的连续性成人患者被纳入。采用简单的四步严重程度量表评估膀胱不适：无疼痛;轻度疼痛（仅通过与患者面谈发现）;中度（患者自发投诉）和重度不适（激动、大声投诉和试图取出膀胱导管）。通过单因素和多因素分析确定CRBD的预测因素。- 纳入164例患者，其中47%主诉CRBD（轻度CRBD：20%;中度或重度CRBD：27%）。多因素Logistic回归分析显示，Foley导管直径上级18 G Fr（OR = 2.2，CI 95 [1.0-5.1]，P = 0.06）和男性（OR = 3.2，CI 95 [1.0-10.5]，P < 0.06）是PACU中重度CRBD的独立预测因素。- 这项观察性研究确定了PACU中中度和重度CRBD的发生率和预测因素。未来的研究有必要评估术前抗毒蕈碱药物或加巴喷丁对男性或18 G Fr Foley导管患者的影响。(C)2010年Elsevier Masson SAS。All rights reserved.
Background. - Catheter-related bladder discomfort (CRBD) is often reported to be stressful and resistant to conventional opioid therapy in the post anaesthesia care unit (PACU). Tolterodine or oxybutynin or gabapentin given orally 1 hour before induction reduce the incidence and severity of CRBD postoperatively. Nevertheless, side effects may occur with these drugs. Thus, preadministration of these different drugs should be selective in patients with predictors of moderate or severe CRBD. The goal of this study was to determine the incidence and predictors of early postoperative CRBD in post-anesthesia care unit.Methods. - We designed a prospective observational study in two teaching hospitals. Consecutive adult patients undergoing surgery under general anaesthesia necessitating intraoperative urinary catheterization were included during a 6-month period. Bladder discomfort was assessed with a simple four-step severity scale: no pain; mild pain (revealed only by interviewing the patient); moderate (a spontaneous complaint by the patient) and severe discomfort (agitation, loud complaints and attempt to remove the bladder catheter). Predictors of CRBD were identified by univariate and multivariate analysis.Results. - 164 patients were included, of which 47% complained of CRBD (mild CRBD: 20%; moderate or severe CRBD: 27%). Multivariate logistic regression analysis showed the diameter of the Foley catheter superior than 18 G Fr (OR = 2.2, CI95 [1.0-5.1], P = 0.06) and male gender (OR = 3.2, CI95 [1.0-10.5], P < 0.06) to be independent predictors of moderate or severe CRBD in the PACU.Conclusion. - This observational study identified the incidence and predictive factors of moderate and severe CRBD in the PACU. Future studies are warranted to assess the impact of preoperative antimuscarinic drugs or Gabapentin on males or patients with 18 G Fr Foley catheters. (C) 2010 Elsevier Masson SAS. All rights reserved.