Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit
Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit
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DOI：
10.1093/bja/aeu442
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发表时间：
2015-09-01
影响因子：
9.8
通讯作者：
Hughes, C.
中科院分区：
文献类型：
--
作者：
Card, E.;Pandharipande, P.;Hughes, C.
背景：麻醉后苏醒通常伴有谵妄的体征，包括精神状态波动和注意力不集中。谵妄的这些迹象的演变需要调查，因为deliriumin麻醉后监护室（PACU）可能与更糟糕的outcomes.Methods：成人患者出现麻醉进行了评估激动出现在手术室使用里士满激动镇静量表（RASS）。然后使用重症监护室的混乱评估方法评估PACU入院时和PACU停留30分钟、1小时和出院时的谵妄体征。根据阳性CAM-ICU评估和伴随RASS评分，将与谵妄一致的体征分类为活动过度与活动减退。多变量Logistic回归被用来评估潜在的危险因素，谵妄在PACU停留期间，包括年龄，美国麻醉医师协会分类，阿片类药物和苯二氮卓类药物exposition.Results：在400例患者中，19%有激动的出现。分别有124例（31%）、59例（15%）、32例（8%）和15例（4%）患者在PACU入院、30 min、1 h和PACU出院时出现谵妄体征。在有谵妄体征的患者中，56%的患者在PACU入院时出现活动减退体征，92%的患者在PACU住院期间出现活动减退体征。围手术期阿片类药物与谵妄体征在PACU stay（P=0.02）。结论：一个显着的比例的患者在术后立即出现谵妄体征，主要表现为低活动亚型。这些体征通常持续到PACU出院，提示需要在PACU中进行结构性谵妄监测，以识别术后可能存在更差结局风险的患者。
Background: Emergence from anaesthesia is often accompanied by signs of delirium, including fluctuating mental status and inattention. The evolution of these signs of delirium requires investigation since deliriumin the post-anaesthesia care unit (PACU) may be associated with worse outcomes.Methods: Adult patients emerging from anaesthesia were assessed for agitated emergence in the operating room using the Richmond Agitation-Sedation Scale (RASS). The Confusion Assessment Method for the Intensive Care Unit was then used to evaluate delirium signs at PACU admission and during PACU stay at 30 min, 1 h, and discharge. Signs consistent with delirium were classified as hyperactive vs hypoactive based upon a positive CAM-ICU assessment and the concomitant RASS score. Multivariable logistic regression was utilized to assess potential risk factors for delirium during PACU stay including age, American Society of Anesthesiologists classification, and opioid and benzodiazepine exposure.Results: Among 400 patients enrolled, 19% had agitated emergence. Delirium signs were present at PACU admission, 30 min, 1 h, and PACU discharge in 124 (31%), 59 (15%), 32 (8%), and 15 (4%) patients, respectively. In patients with delirium signs, hypoactive signs were present in 56% at PACU admission and in 92% during PACU stay. Perioperative opioids were associated with delirium signs during PACU stay (P=0.02).Conclusions: A significant proportion of patients develop delirium signs in the immediate postoperative period, primarily manifesting with a hypoactive subtype. These signs often persist to PACUdischarge, suggesting the need for structured delirium monitoring in the PACU to identify patients potentially at risk for worse outcomes in the postoperative period.