Towards a better understanding of anesthesia emergence mechanisms: Research and clinical implications.
Towards a better understanding of anesthesia emergence mechanisms: Research and clinical implications.
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DOI：
10.5662/wjm.v8.i2.9
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发表时间：
2018-10-12
期刊：
影响因子：
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通讯作者：
Muzio MR
中科院分区：
文献类型：
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作者：
Cascella M;Bimonte S;Muzio MR
麻醉苏醒（AE）是麻醉的结束阶段，其特征是从无意识过渡到完全清醒和意识恢复（RoC）。在这一关键阶段可能发生各种不良并发症，包括咳嗽、呼吸/心血管事件和精神状态变化，如苏醒期谵妄和延迟性RoC。在全身麻醉过程中，诱导和AE代表了“滞后”的神经生物学示例。事实上，AE机制不应简单地视为诱导阶段发生的事件的逆转事件。麻醉诱导的意识丧失（LoC）和AE直到RoC是相当不同的现象，部分是不同的神经生物学。尽管麻醉主要通过影响皮层连接来产生意识线，但麻醉结束时的唤醒过程是由大脑深处的结构触发的，而不是在新皮层内诱导的。这项工作的目的是提供一个概述AE过程的研究，在机制方面，和脑电图的结果。由于该领域的研究大多涉及临床前研究，因此提出了翻译建议和研究前景。然而，很少有人知道AE神经生物学之间的关系，和潜在的并发症发生在出现，后RoC。因此，本综述的另一个范围是强调为什么更好地理解AE机制可能具有重要的临床意义，例如改善患者的恢复质量，避免术后早期和晚期并发症。
Emergence from anesthesia (AE) is the ending stage of anesthesia featuring the transition from unconsciousness to complete wakefulness and recovery of consciousness (RoC). A wide range of undesirable complications, including coughing, respiratory/cardiovascular events, and mental status changes such as emergence delirium, and delayed RoC, may occur during this critical phase. In general anesthesia processes, induction and AE represent a neurobiological example of “hysteresis”. Indeed, AE mechanisms should not be simply considered as reverse events of those occurring in the induction phase. Anesthesia-induced loss of consciousness (LoC) and AE until RoC are quite distinct phenomena with, in part, a distinct neurobiology. Althoughanaesthetics produce LoC mostly by affecting cortical connectivity, arousal processes at the end of anesthesia are triggered by structures deep in the brain, rather than being induced within the neocortex. This work aimed to provide an overview on AE processes research, in terms of mechanisms, and EEG findings. Because most of the research in this field concerns preclinical investigations, translational suggestions and research perspectives are proposed. However, little is known about the relationship between AE neurobiology, and potential complications occurring during the emergence, and after the RoC. Thus, another scope of this review is to underline why a better understanding of AE mechanisms could have significant clinical implications, such as improving the patients’ quality of recovery, and avoiding early and late postoperative complications.