术中低浓度吸入麻醉下脑电图抑制可预示术后ICU谵妄的发生
Intraoperative electroencephalogram suppression at lower volatile anaesthetic concentrations predicts postoperative delirium occurring in the intensive care unit
术后谵妄是一种与发病率和死亡率增加相关的常见并发症，最近的研究报道术中脑电图抑制与术后谵妄之间具有相关性。因此，我们假设在较低的挥发性麻醉剂浓度下脑电图抑制的患者术后谵妄的发生率更高。
本回顾性队列研究纳入了618名选择性手术患者，均接受重症监护室监护，并接受了术中脑电图监测，且在医疗记录中进行了谵妄评估。使用混合效应模型评估对挥发性麻醉剂的敏感性，该混合效应模型在每个时间点基于当前的呼气末麻醉剂浓度预测脑电图抑制的可能性。具有高于总体中位数的随机截距（在较低麻醉剂浓度下的脑电图抑制）的患者被归类为对挥发性麻醉剂具有更高的敏感性。对重症监护病房进行术后谵妄的测量，每12小时就会对所有患者进行一次CAM-ICU评估。如果在术后第一天至术后第5天的电子病历中记录了一个或多个阳性的CAM-ICU评估，则定义为患者经历了术后谵妄。
在较低挥发性麻醉剂浓度下脑电图抑制的患者术后谵妄的发生率增加。这些患者似乎表现出对麻醉剂的高敏感性。
Fritz B A, Maybrier H R, Avidan M S. Intraoperative electroencephalogram suppression at lower volatile anaesthetic concentrations predicts postoperative delirium occurring in the intensive care unit[J]. British Journal of Anaesthesia, 2018, 121(1):241.
Background: Postoperative delirium is a common complication associated with increased morbidity and mortality. A recently-reported association between intraoperative electroencephalogram suppression and postoperative delirium might be mediated in some patients by a heightened sensitivity to volatile anaesthetics.
Methods: This retrospective cohort study included 618 elective surgery patients with planned intensive care unit
admission, who also received intraoperative electroencephalogram monitoring and had delirium assessments documented in the medical record. Sensitivity to volatile anaesthetics was assessed using a mixed effects model predicting the likelihood of electroencephalogram suppression at each time point based on the current end-tidal anaesthetic concentration. Patients with a random intercept above the population median (electroencephalogram suppression at lower anaesthetic concentrations) were classified as having heightened sensitivity to volatile anaesthetics. Delirium was defined as a positive Confusion Assessment Method for the Intensive Care Unit assessment anytime in the first five postoperative days.
Results: Postoperative delirium was observed in 162 of 618 patients (26%). Patients who experienced electroencephalogram suppression at lower volatile anaesthetic concentrations had a higher incidence of postoperative delirium [109/309 (35%)] than other patients [53/309 (17%)] [unadjusted odds ratio 2.63; 95% confidence interval (CI), 1.81e3.84, P<0.001]. This association remained significant after adjusting for patient characteristics, surgical variables, and duration of electroencephalogram suppression (adjusted odds ratio 2.13; 95% CI 1.24e3.65, P¼0.006).
Conclusions: These data support the hypothesis that patients with electroencephalogram suppression at lower volatile anaesthetic concentrations have an increased incidence of postoperative delirium. Such patients appear to exhibit a phenotype of anaesthetic sensitivity, which might predispose them to adverse cognitive outcomes.
罂粟花
麻醉学文献进展分享
联系我们