小儿七氟醚麻醉苏醒期的临床行为特征和脑电图类型：一项观察研究
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Clinical signs and electroencephalographic patterns of
emergence from sevoflurane anaesthesia in children：
An observational study
背景
很少有研究系统地描述了小儿麻醉苏醒期的临床行为体征、脑电图（EEG）类型和年龄之间的关系。
方 法
为了定义0-3岁小儿七氟醚加入或不加入笑气麻醉苏醒期，呼末七氟醚浓度与脑电图特征、年龄之间的关系，临床行为特征的恢复也可以作为麻醉苏醒的预测。假设苏醒期临床行为特征是连续的，对于3个月以上的婴儿，脑电图α波的变化与临床行为特征相关。0至3岁95名颈部以下需要手术的儿童入组。测量指标为出现第一次粗体运动、咳嗽、痛苦表情及不良共轭凝视的呼末七氟醚浓度及时间，脑电图（F7 / F8）α波功率（8到12赫兹），β波功率,手术结束时间。
结 果
苏醒期临床行为特征遵循所有年龄段有序的事件顺序。呼末低浓度七氟醚就可引起临床行为特征的改变，年龄为独立因素，[对于七氟醚浓度，出现身体运动为：0.4％（95％置信区间（CI），0.3至0.4），咳嗽为0.3％（95％CI，0.3至0.4），痛苦表情为 0.2％（95％CI，0至0.3）; 年龄无关，P> 0.5]不良共轭凝视在0%-1%呼末七氟醚浓度下就可以观察到，3个月的小儿在2%呼末七氟醚下可以观察到α波共振，而在0.5%浓度下消失。几乎每个病人在α波消失的5分钟内可以观察到身体运动。笑气对可以引起身体运动、咳嗽的呼末七氟醚浓度及时间无影响。
结 论
苏醒期的几个临床行为特征按顺序出现，不受笑气影响。眼睛的位置与呼末七氟醚浓度及其他苏醒期临床行为特征相关性较差。脑电图有助于预测3个月以上小儿的苏醒期临床行为特征。
原始文献摘要
Cornelissen L, Donado C, Lee JM, et al. Clinical signs and electroencephalographic patterns of emergence from sevoflurane anaesthesia in children: An observational study[J]. European journal of anaesthesiology, 2017.
BACKGROUND Few studies have systematically described relationships between clinical–behavioural signs, electroencephalographic (EEG) patterns and age during emergence from anaesthesia in young children.
OBJECTIVE To identify the relationships between end-tidal sevoflurane (ETsevoflurane) concentration, age and frontal EEG spectral properties in predicting recovery of clinical–behavioural signs during emergence from sevoflurane in children 0 to 3 years of age, with and without exposure to nitrous oxide. The hypothesis was that clinical signs occur sequentially during emergence, and that for infants aged more than 3 months, changes in alpha EEG power are
correlated with clinical–behavioural signs.
DESIGN An observational study.
SETTING A tertiary paediatric teaching hospital from December 2012 to August 2016.
PATIENTS Ninety-five children aged 0 to 3 years who required surgery below the neck.
OUTCOME MEASURES Time–course of, and ET sevoflurane concentrations at first gross body movement, first cough, first grimace, dysconjugate eye gaze, frontal (F7/F8) alpha EEG power (8 to 12 Hz), frontal beta EEG power (13 to 30 Hz), surgery-end.
RESULTS Clinical signs of emergence followed an orderly sequence of events across all ages. Clinical signs occurred over a narrow ET sevoflurane, independent of age [movement: 0.4% (95% confidence interval (CI), 0.3 to 0.4), cough 0.3% (95% CI, 0.3 to 0.4), grimace 0.2% (95% CI, 0 to 0.3); P > 0.5 for age vs. ET sevoflurane]. Dysconjugate eye gaze was observed between ET sevoflurane 1 to 0%. In children more than 3 months old, frontal alpha EEG oscillations were
present at ET sevoflurane 2.0% and disappeared at 0.5%. Movement occurred within 5 min of alpha oscillation disappearance in 99% of patients. Nitrous oxide had no effect on the time course or ET sevoflurane at which children showed body movement, grimace or cough.
CONCLUSION Several clinical signs occur sequentially during emergence, and are independent of exposure to nitrous oxide. Eye position is poorly correlated with other clinical signs or ET sevoflurane. EEG spectral characteristics may aid prediction of clinical–behavioural signs in children more than 3 months.
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