术前口服咪达唑仑达满意镇静的时机对扁桃体腺样体切除术儿童麻醉诱导及苏醒期的影响

Effects of the timing of satisfactory sedation with preoperative oral midazolam on anesthesia induction and recovery in children undergoing adenotonsillectomy

目的:探讨术前口服咪达唑仑达满意镇静的时机对扁桃体腺样体切除术儿童麻醉诱导及苏醒期的影响。方法:选取2022年11月至2023年6月在温州医科大学附属第二医院择期行扁桃体腺样体切除患儿147例,美国麻醉医师协会(ASA)Ⅰ或Ⅱ级,年龄2~7岁。患儿在术前等候区口服0.5 mg/kg咪达唑仑,并根据咪达唑仑口服后达到满意镇静时间分为10~20 min(快速起效,M_(1)组)及21~30 min(缓慢起效,M_(2)组),或口服等容量冰糖梨饮品(空白对照组,C组)。三组均采用丙泊酚+芬太尼联合七氟烷诱导、七氟烷维持的全身麻醉方案。主要观察指标为患儿诱导依从性(ICC)评分和麻醉后恢复室(PACU)的小儿麻醉苏醒期躁动(PAED)评分评估苏醒期躁动(EA)发生情况,次要观察指标包括父母分离焦虑量表(PSAS)、镇静Ramsay评分、手术时间、苏醒时间、PACU停留时间、出院时间、围术期呼吸系统不良事件(PRAE)及其他病房内不良事件等。结果:共147例患儿纳入结果分析,每组49例。M_(1)、M_(2)组患儿完美诱导(ICC=0)占比显著优于C组(95.9%vs.91.8%vs.61.2%,P=0.001)。M_(1)组患儿最大及平均PAED评分较C组显著升高(6.4±5.0 vs.4.4±4.1,P=0.029;5.2±4.5 vs.3.4±3.6,P=0.030);EA发生率明显高于C组(30.6%vs.10.2%,P=0.022),较M_(2)组有所增加(OR=0.581,95%CI 0.231-1.463,P=0.354)。M_(2)组最大及平均PAED评分、EA发生率与C组相比差异均无统计学意义(P>0.05)。两M组患儿入室Ramsay评分及PSAS评分高于C组(P<0.05),PACU停留时间及苏醒时间长于C组(P<0.05);M_(1)组患儿PACU疼痛评分高于C组(P<0.05)。三组患儿手术时间、出院时间、PRAE及其他病房内不良事件等比较,差异均无统计学意义(P>0.05)。结论:术前口服咪达唑仑虽可改善诱导期患儿ICC及PSAS评分,但也导致苏醒时间及PACU停留时间延长。咪达唑仑快速起效未发现更优的诱导期和苏醒期质量,反而增加了EA发生率及术后疼痛评分。

AIM:To investigate the effect of the timing of satisfactory sedation with preoperative oral midazolam on anesthesia induction and recovery in children undergoing adenotonsillectomy.METHODS:A total of 147 children undergoing elective adenotonsillectomy,with ASA physical statusⅠorⅡ,aged 2-7 years were selected from November 2022 to June 2023 in the Second Affiliated Hospital of Wenzhou Medical University.The children were orally administered 0.5 mg/kg midazolam in preoperative waiting area and were divided into 10-20 min(rapid onset,M_(1)group)and 21-30 min(slow onset,M2 group)based on the satisfactory sedation time,or equal volume of sugar pear drink orally(blank control group,C group).Children in all three groups received a general anesthesia method of propofol+fentanyl combined with sevoflurane induction and sevoflurane maintenance.The primary outcome measures were the induction compliance checklist(ICC)score and the pediatric anesthesia emergence delirium(PAED)score in the post-anesthesia care unit(PACU)to assess the occurrence of emergence agitation(EA),and the secondary outcome measures included the parental separation anxiety scale(PSAS),sedation Ramsay score,surgery duration,recovery time,PACU stay time,discharge time,the incidence of perioperative respiratory adverse events(PRAE)and other adverse events in the ward.RESULTS:147 children were included in the result analysis,with 49 cases in each group.The proportion of perfect induction(ICC=0)were significantly higher in two M groups than that in group C(95.9%vs.91.8%vs.61.2%,P=0.001).The maximum and average PAED score in PACU in group M_(1)showed a significantly higher(6.4±5.0 vs.4.4±4.1,P=0.029;5.2±4.5 vs.3.4±3.6,P=0.030),and the incidence of EA was significantly higher than those in group C(10.2%vs.30.6%,P=0.022),and increased compared to the group M2(OR=0.581,95%CI 0.231-1.463,P=0.354).There was no statistically significant difference in the maximum and average PAED scores,incidence of EA between group M2 and group C(P>0.05).The Ramsay score and PSAS score in two M groups were higher,PACU stay time and recovery time was longer than those in group C(P<0.05).The pain scores in PACU in group M_(1)was higher than that of group C(P<0.05).There was no statistically significant difference in the surgical time,discharge time,the incidence of PRAE and other adverse events in the ward among three groups(P>0.05).CONCLUSION:Preoperative oral midazolam can improve the ICC and PSAS scores of children during induction,but it also leads to prolonged recovery time and PACU retention time.The rapid onset of midazolam did not result in better induction and recovery quality,but instead increased the incidence of EA and postoperative pain score.