EEG-Parameter-Guided Anesthesia for Prevention of Emergence Delirium in Children.
EEG-Parameter-Guided Anesthesia for Prevention of Emergence Delirium in Children.
复制标题
脑电图参数引导麻醉预防儿童苏醒性谵妄
DOI：
10.3390/brainsci12091195
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发表时间：
2022-09-05
期刊：
影响因子：
3.3
通讯作者：
Zhang, Jiaqiang
中科院分区：
文献类型：
--
作者：
Han, Yaqian;Miao, Mengrong;Li, Pule;Yang, Yitian;Zhang, Hui;Zhang, Beibei;Sun, Mingyang;Zhang, Jiaqiang
背景：紧急谵妄（艾德）通常发生在儿童手术后，发生率为10 - 80%。虽然艾德大多数是自限性的，但其潜在的损伤不容忽视。脑电图（EEG）参数引导麻醉是否可以减少小儿外科艾德的发生率尚未得到充分的讨论。方法：选择54例在七氟醚麻醉下接受尿道下裂手术的2-12岁男孩。EEG参数指导组（E组）采用七氟醚麻醉诱导，通过将边缘频率（SEF）调整至10-15，结合DSA功率谱和原始EEG监测维持麻醉。而在对照组（C组）中，麻醉师对SedLine屏幕（包括SEF、DSA和原始EEG）不知情，并根据他们的经验调整术中药物使用。小儿麻醉苏醒期谵妄（PA艾德）评分> 10分的患者被诊断为艾德，而PA艾德评分> 2分的患者被诊断为苏醒期激越（EA）。结果：最终，共有37例患者入选本试验。E组的艾德发生率低于C组（5.6% vs. 36.8%; p = 0.04），而两组的EA发生率相似（61% vs. 78.9%; p = 0.48）。两组之间的瑞芬太尼剂量和平均动脉压（MAP）下降等术中参数无差异（p > 0.05），但E组的平均七氟醚呼气末浓度（EtSevo）低于C组（p > 0.05）。此外，在PACU停留期间，两组的拔管时间和出院时间相似，而E组拔管5分钟内的PAED评分和拔管30分钟内的面部、腿部、活动、哭泣和舒适性（FLACC）评分均低于C组。结论：脑电图参数指导麻醉管理可降低小儿艾德的发生率。需要更大样本量的研究以获得更令人信服的结果。
Background: Emergence delirium (ED) usually occurs in children after surgery with an incidence of 10−80%. Though ED is mostly self-limited, its potential injuries cannot be ignored. Whether electroencephalography (EEG)-parameter-guided anesthesia could reduce the incidence of ED in pediatric surgery has not been fully discussed to date. Methods: Fifty-four boys aged 2–12 years undergoing elective hypospadias surgery under sevoflurane anesthesia were selected. In the EEG-parameter-guided group (E group), sevoflurane was used for anesthesia induction and was maintained by titrating the spectral edge frequency (SEF) to 10–15 and combining the monitoring of density spectral array (DSA) power spectra and raw EEG. While in the control group (C group), anesthesiologists were blinded to the SedLine screen (including SEF, DSA, and raw EEG) and adjusted the intraoperative drug usage according to their experience. Patients with a Pediatric Anesthesia Emergence Delirium (PAED) score > 10 were diagnosed with ED, while patients with a PAED score > 2 were diagnosed with emergence agitation (EA). Results: Finally, a total of 37 patients were included in this trial. The incidence of ED in the E group was lower than in the C group (5.6% vs. 36.8%; p = 0.04), while the incidence of EA was similar in the two groups (61% vs. 78.9%; p = 0.48). Intraoperative parameters including remifentanil dosage and the decrease in mean arterial pressure (MAP) were not different between the two groups (p > 0.05), but the mean end-tidal sevoflurane concentration (EtSevo) was lower in the E group than in the C group (p > 0.05). Moreover, during PACU stay, the extubation time and discharge time of the groups were similar, while the PAED scores within 5 min from extubation and the Face, Legs, Activity, Cry, and Consolability (FLACC) scores within 30 min from extubation were lower in the E group than in the C group. Conclusion: EEG-parameter-guided anesthesia management reduced the incidence of ED in children. Studies with larger sample sizes are needed to obtain more convincing results.
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影响因子：
5.7
作者：
Denman, WT;Swanson, EL;Rosow, CE
通讯作者：
Rosow, CE
影响因子：
2.9
作者：
Lee SJ;Sung TY
通讯作者：
Sung TY
DOI：
10.1016/j.bpa.2005.07.008
发表时间：
2006-03-01
影响因子：
4.8
作者：
Drover, David;Ortega, H. R. (Rick)
通讯作者：
Ortega, H. R. (Rick)
影响因子：
2.1
作者：
Bresil, P.;Nielsson, M. S.;Lambert, P. H.
通讯作者：
Lambert, P. H.
影响因子：
--
作者：
Lange S;Mędrzycka-Dąbrowska W;Friganovic A;Oomen B;Krupa S
通讯作者：
Krupa S