Influencing factors and risk prediction model for emergence agitation after general anesthesia for primary liver cancer

BACKGROUND General anesthesia is commonly used in the surgical management of gastrointestinal tumors;however,it can lead to emergence agitation(EA).EA is a common complication associated with general anesthesia,often characterized by behaviors,such as crying,struggling,and involuntary limb movements in patients.If treatment is delayed,there is a risk of incision cracking and bleeding,which can significantly affect surgical outcomes.Therefore,having a proper understanding of the factors influencing the occurrence of EA and implementing early preventive measures may reduce the incidence of agitation during the recovery phase from general anesthesia,which is beneficial for improving patient prognosis.AIM To analyze influencing factors and develop a risk prediction model for EA occurrence following general anesthesia for primary liver cancer.METHODS Retrospective analysis of clinical data from 200 patients who underwent hepatoma resection under general anesthesia at Wenzhou Central Hospital(January 2020 to December 2023)was conducted.Post-surgery,the Richmond Agitation-Sedation Scale was used to evaluate EA presence,noting EA incidence after general anesthesia.Patients were categorized by EA presence postoperatively,and the influencing factors were analyzed using logistic regression.A nomogram-based risk prediction model was constructed and evaluated for differentiation and fit using receiver operating characteristics and calibration curves.RESULTS EA occurred in 51(25.5%)patients.Multivariate analysis identified advanced age,American Society of Anesthesiologists(ASA)grade Ⅲ,indwelling catheter use,and postoperative pain as risk factors for EA(P<0.05).Conversely,postoperative analgesia was a protective factor against EA(P<0.05).The area under the curve of the nomogram was 0.972[95%confidence interval(CI):0.947-0.997]for the training set and 0.979(95%CI:0.951-1.000)for the test set.Hosmer-Lemeshow test showed a good fit(χ^(2)=5.483,P=0.705),and calibration curves showed agreement between predicted and actual EA incidence.CONCLUSION Age,ASA grade,catheter use,postoperative pain,and analgesia significantly influence EA occurrence.A nomogram constructed using these factors demonstrates strong predictive accuracy.

Observation of the Effects of Anesthesia Recovery Nursing Combined with Heat Preservation Measures in Patients Undergoing General Anesthesia Surgery

Objective:To observe the application effects of anesthesia recovery nursing with heat preservation measures in patients undergoing general anesthesia surgery.Methods:300 cases of general anesthesia surgery patients in our hospital from March 2023 to February 2024 were selected and divided into the control group and the observation group according to the random number table method,each with 150 cases.The control group adopted conventional care,while the observation group was given anesthesia recovery care and heat preservation measures on the basis of conventional care.The wake-up time,extubation time,hospitalization time,and the incidence of adverse reactions were compared between the two groups and statistically analyzed.Results:The wake-up time of patients in the control group was 9.71±1.20 hours,and that of the observation group was 6.51±1.02 hours,with statistically significant differences(P<0.05);the extubation times of patients in the observation group and the control group after awakening were 8.52±0.41 min and 10.42±1.12 min,respectively,with statistically significant differences(P<0.05)The hospital stay after the operation in the observation group and the control group was 32.91±4.71 days and 37.24±3.34 days respectively,and the difference was statistically significant(P<0.05),and the incidence rate of adverse reactions after extubation in the observation group(3.33%)was significantly lower than that in the control group(10.00%)(P<0.05).Conclusion:In general anesthesia surgery patients,the implementation of anesthesia recovery nursing with heat preservation measures can significantly improve the physical condition of patients,effectively shorten the duration of surgery and patients’wake-up time,and improve their quality of life,which is worthy of clinical promotion and application.

Comparative Study and Safe Dose Analysis of Dexmedetomidine in the Prevention of Emergence Agitation and Emergency Delirium in Children Undergoing General Anesthesia

The purpose of this paper is to explore the safe and effective dose of dexmedetomidin for the prevention of agitation and delirium during the awakening period for children undergoing general anesthesia. Samples of 989 cases are collected from children with comprehensive treatment of dental caries, and were randomly divided into four groups. Group A, group B and group C were intravenously at constant speed （60 mL/h）, 0.5 and 0.25 infusion with 1 μg/kg dexmedetomidine. Group D （control group） was intravenously saline at the same speed. The score of 5-point scale and the incidence of ED （emergency delirium） and EA （emergence agitation） in four groups were compared. Comparison of four groups of CHIPPS （children and infants postoperative pain） score, the amount of operation time and record seven halothane （TO）, time to stop cover drug withdrawal of laryngeal anesthesia （TM）, eye opening time （TE）, independent records of children at the time of ICU stay after anesthesia （TP）. Results show that there was no significant difference between the four groups （p 〉 0.05）, among which the TM in B, C groups was significantly higher than that in A, D groups （p 〈 0.05）. Group C was significantly higher than group B （p 〈 0.05）. There was no significant difference in TE and TP between the A, B, D groups （p 〉 0. 05）. TE in group C was significantly higher than that in groups A, D （p 〉 0. 05）. The TP of group C was significantly higher than that of groups A, D （p 〈 0.05）, but there was no significant difference between the B, C groups （p 〉 0.05）. The incidence rates of EA and ED in groups A and B were significantly lower than those in group D （p 〈 0.05）. Group C was significantly lower than group A （p 〈 0.05）. There was no significant difference between group C and group C （p 〉 0.05）. The CHIPPS score and sevoflurane dosage in groups A and B were significantly lower than those in group D （p 〈 0.05）. Group C was significantly lower than group A （p 〈 0.05）. There was no significant difference between group C （p 〉 0.05）. Conclusion： the dose of dexmetomidine 0.5 μg/kg in children with general anesthesia can prevent restlessness and delirium after operation.

Comparison of Propofol and Fentanyl for Preventing Emergence Agitation Following Sevoflurane Anesthesia in Pediatric Patients: A Single-Center Study in Bangladesh

Background: Emergence agitation (EA) is a common phenomenon observed in pediatric patients following general anesthesia. This study aimed to assess the efficacy of propofol and fentanyl in preventing EA and to compare their associated complications or side effects. Methods: This prospective randomized observational comparative study was conducted at Dhaka Medical College Hospital from July 2013 to June 2014. The study aimed to evaluate the effects of propofol and fentanyl on EA in children aged 18 to 72 months undergoing circumcision, herniotomy, and polypectomy operations. Ninety children were included in the study, with 45 in each group. Patients with psychological or neurological disorders were excluded. Various parameters including age, sex, weight, American Society of Anesthesiologists (ASA) class, duration of anesthesia, Saturation of Peripheral Oxygen (SPO2), heart rate (HR), respiratory rate (RR), Pediatric Anesthesia Emergence Delirium (PAED) score, duration of post-anesthesia care unit (PACU) stay, incidence of laryngospasm, nausea, vomiting, and rescue drug requirement were compared between the two groups. Results: Age, sex, weight, ASA class, and duration of anesthesia were comparable between the two groups. Perioperative SpO2 and HR were similar in both groups. However, the PAED score was significantly higher in the fentanyl group during all follow-ups except at 30 minutes postoperatively. The mean duration of PACU stay was significantly longer in the fentanyl group. Although the incidence of laryngospasm was higher in the fentanyl group, it was not statistically significant. Conversely, nausea or vomiting was significantly higher in the fentanyl group. The requirement for rescue drugs was significantly higher in the fentanyl group compared to the propofol group. Conclusion: Both propofol and fentanyl were effective in preventing emergence agitation in pediatric patients undergoing various surgical procedures under sevoflurane anesthesia. However, propofol demonstrated a better safety profile with fewer incidences of nausea, vomiting, and rescue drug requirements compared to fentanyl.

Factors influencing agitation during anesthesia recovery after laparoscopic hernia repair under total inhalation combined with caudal block anesthesia

BACKGROUND Laparoscopic hernia repair is a minimally invasive surgery,but patients may experience emergence agitation(EA)during the post-anesthesia recovery period,which can increase pain and lead to complications such as wound reopening and bleeding.There is limited research on the risk factors for this agitation,and few effective tools exist to predict it.Therefore,by integrating clinical data,we have developed nomograms and random forest predictive models to help clinicians predict and potentially prevent EA.AIM To establish a risk nomogram prediction model for EA in patients undergoing laparoscopic hernia surgery under total inhalation combined with sacral block anesthesia.METHODS Based on the clinical information of 300 patients who underwent laparoscopic hernia surgery in the Nanning Tenth People’s Hospital,Guangxi,from January 2020 to June 2023,the patients were divided into two groups according to their sedation-agitation scale score,i.e.,the EA group(≥5 points)and the non-EA group(≤4 points),during anesthesia recovery.Least absolute shrinkage and selection operator regression was used to select the key features that predict EA,and incorporating them into logistic regression analysis to obtain potential pre-dictive factors and establish EA nomogram and random forest risk prediction models through R software.RESULTS Out of the 300 patients,72 had agitation during anesthesia recovery,with an incidence of 24.0%.American Society of Anesthesiologists classification,preoperative anxiety,solid food fasting time,clear liquid fasting time,indwelling catheter,and pain level upon awakening are key predictors of EA in patients undergoing laparoscopic hernia surgery with total intravenous anesthesia and caudal block anesthesia.The nomogram predicts EA with an area under the receiver operating characteristic curve(AUC)of 0.947,a sensi-tivity of 0.917,and a specificity of 0.877,whereas the random forest model has an AUC of 0.923,a sensitivity of 0.912,and a specificity of 0.877.Delong’s test shows no significant difference in AUC between the two models.Clinical decision curve analysis indicates that both models have good net benefits in predicting EA,with the nomogram effective within the threshold of 0.02 to 0.96 and the random forest model within 0.03 to 0.90.In the external model validation of 50 cases of laparoscopic hernia surgery,both models predicted EA.The nomogram model had a sensitivity of 83.33%,specificity of 86.84%,and accuracy of 86.00%,while the random forest model had a sensitivity of 75.00%,specificity of 78.95%,and accuracy of 78.00%,suggesting that the nomogram model performs better in predicting EA.CONCLUSION Independent predictors of EA in patients undergoing laparoscopic hernia repair with total intravenous anesthesia combined with caudal block include American Society of Anesthesiologists classification,preoperative anxiety,duration of solid food fasting,duration of clear liquid fasting,presence of an indwelling catheter,and pain level upon waking.The nomogram and random forest models based on these factors can help tailor clinical decisions in the future.

Application of early enteral nutrition nursing based on enhanced recovery after surgery theory in patients with digestive surgery

BACKGROUND Postoperative nursing can improve the restlessness and gastrointestinal function of patients with tracheal intubation under general anesthesia in digestive surgery.Wide application of various nursing methods and routine nursing in periop-erative nursing of patients with general anesthesia in digestive surgery.AIM To investigate the impact of early postoperative enteral nutrition nursing based on the enhanced recovery after surgery(ERAS)theory on postoperative agitation and gastrointestinal recovery in patients undergoing general anesthesia that experienced tracheal intubation.METHODS The data of 126 patients with digestive surgery from May 2019 to February 2022 were retrospectively analyzed.According to different nursing methods,they were divided into control group and observation group,with 63 cases in observation group and 63 cases in control group.The patients in the control group had standard perioperative nursing care,whereas those in the observation group got enteral nourishment as soon as possible after surgery in accordance with ERAS theory.Both the rate and quality of gastrointestinal function recovery were compared between the two groups after treatment ended.Postoperative anes-thesia-related adverse events were tallied,patients'nutritional statuses were monitored,and the Riker sedation and agitation score(SAS)was used to measure the incidence of agitation.RESULTS When compared to the control group,the awake duration,spontaneous breathing recovery time,extubation time and postoperative eye-opening time were all considerably shorter(P<0.05).There was no significant difference in the recovery time of orientation force between the two groups(P>0.05);however,the observation group had a lower SAS score than the control group(P<0.05).The recovery time for normal intestinal sounds,the time it took to have the first postoperative exhaust,the time it took to have the first postoperative defecation,and the time it took to have the first postoperative half-fluid feeding were all faster in the observation group than in the control group(P<0.05);Fasting blood glucose was lower in the observation group compared to the control group(P<0.05),while the albumin and hemoglobin levels were higher on the first and third postoperative days;however,there was no statistically significant difference in the incidence of anesthesia-related adverse reactions between the two groups(P>0.05).CONCLUSION The extremely early postoperative enteral nutrition nursing based on ERAS theory can reduce the degree of agitation,improve the quality of recovery,promote the recovery of gastrointestinal function,and improve the nutritional status of patients in the recovery period after tracheal intubation under general anesthesia.

ERAS理念下的舒适护理对患者术后麻醉苏醒质量躁动情况及疼痛程度的影响

目的 探讨加速康复外科(ERAS)理念下的舒适护理对全身麻醉患者术后麻醉苏醒质量、躁动情况及疼痛程度的影响。方法 将136例全身麻醉手术患者按照随机数字表法分为对照组和研究组,每组68例。对照组患者给予常规麻醉恢复室(PACU)护理,研究组患者在对照组基础上给予ERAS理念下的舒适护理。比较两组患者麻醉苏醒质量(包括导管拔除时间、自主呼吸时间和PACU停留时间)、躁动情况、疼痛程度[采用舒适度行为量表(CBS)和疼痛视觉模拟评分法(VAS)评定]及并发症发生情况。结果 研究组患者术后导管拔除时间、自主呼吸时间早于对照组,PACU停留时间短于对照组(P<0.01)。研究组患者术后躁动率、并发症总发生率、VAS评分低于对照组,CBS评分高于对照组(P<0.05或0.01)。结论 ERAS理念下的舒适护理可改善全麻患者术后麻醉苏醒质量和躁动情况,减轻患者疼痛程度,值得临床推广。

不同频次唤醒护理对全身麻醉胸科腔镜手术后患者苏醒效果的影响

目的探讨不同频次的唤醒护理对全身麻醉胸科腔镜手术后带气管导管转入麻醉后监测治疗室(PACU)患者苏醒效果的影响。方法采用便利抽样法,选取全身麻醉胸科腔镜手术后带气管导管转入气管导管观察的116例患者为研究对象,探讨不同频次(试验组A每5分钟、试验组B每10分钟、对照组等待患者自然苏醒)的唤醒护理对气管导管拔管时间、拔管后苏醒时间、总苏醒时间、拔管时呛咳反应、苏醒期躁动、拔管成功率、拔管后低氧血症和平均动脉压波动发生率的影响。结果气管导管拔管时间三组比较差异有统计学意义,试验组A和试验组B显著短于对照组(均P<0.05);试验组A与试验组B差异无统计学意义(P>0.05)。拔管后苏醒时间三组比较差异有统计学意义,试验组A显著长于对照组(P<0.05)。总苏醒时间三组比较差异无统计学意义(P>0.05)。三组气管导管拔管成功率和拔管后低氧血症发生率比较,差异无统计学意义(均P>0.05)。与对照组相比,试验组A和试验组B拔管时呛咳反应、苏醒期躁动程度和拔管后平均动脉压波动发生率明显降低(均P<0.05)。结论5 min和10 min频次的唤醒护理均能有效减少全身麻醉胸科腔镜手术后患者在气管导管机械通气时间,降低拔管时呛咳反应和苏醒期躁动严重度,有利于维持拔管时血流动力学稳定,提高苏醒质量。

艾司氯胺酮与右美托咪定辅助全麻对小儿腺样体扁桃体切除术PAED评分、苏醒质量和不良反应的影响

目的探讨艾司氯胺酮与右美托咪定辅助全麻对小儿腺样体扁桃体切除术麻醉苏醒期躁动量表(PAED)评分、苏醒质量和不良反应的影响。方法选取2021年10月—2023年10月收治的138例行腺样体扁桃体切除术患儿,采用简单随机数表法分为E组与M组,各69例。2组均予全麻,麻醉诱导前,E组予以艾司氯胺酮静脉注射,M组予以右美托咪定静脉泵注。记录改良Aldrete评分,比较诱导前(T0)、诱导后(T1)、插管时(T2)、腺样体扁桃体剥离时(T3)、拔管时(T4)平均动脉压(MAP)、心率(HR),检测术前、术后1 d应激指标[5-羟色胺(5-HT)、去甲肾上腺素(NE)、肾上腺素(E)、皮质醇(Cor)],记录进入麻醉后恢复室30 min内的最大PAED评分及疼痛行为评分量表(FLACC)评分,记录2组麻醉不良反应。结果E组改良Aldrete评分高于M组(P<0.01)。T0~T4时,E组MAP、HR呈先升高后降低趋势,M组MAP、HR呈先降低后升高趋势,且T2、T3时E组MAP、HR均高于M组(P<0.05)。术后1 d,2组5-HT、NE、E和Cor水平高于术前,但E组低于M组(P<0.05)。E组PAED评分、FLACC评分均低于M组(P<0.05)。2组不良反应发生率比较差异不显著(P>0.05)。结论较右美托咪定,艾司氯胺酮辅助全麻可以降低腺样体扁桃体切除术患儿PAED评分、提高苏醒质量,减轻血流动力学波动和应激性损伤。

手术室麻醉苏醒期护理对腹部手术患者全身麻醉苏醒期躁动的影响

目的探讨手术室麻醉苏醒期护理对腹部手术患者全身麻醉苏醒期躁动(EA)的影响。方法选取2020年1月至2022年10月期间在信阳市中心医院收治的88例腹部手术患者,随机分为对照组和观察组,各44例。对照组予以常规护理,观察组采用手术室麻醉苏醒期护理。比较两组患者苏醒相关指标,EA评分及发生率、苏醒期血压、心率情况以及不良反应发生率。结果观察组麻醉恢复室(PACU)滞留时间、拔管时间、完全苏醒时间短于对照组,差异有统计学意义(P<0.05)。观察组EA发生率(6.82%)低于对照组(27.27%),差异有统计学意义。观察组患者苏醒期心率、血压均较优于对照组,差异有统计学意义(P<0.05)。观察组不良反发生率(4.45%)低于对照组(18.18%),差异有统计学意义(P<0.05)。结论手术室麻醉苏醒期护理可降低腹部手术患者全身麻醉EA发生,保持患者心率、血压稳定,降低术后不良事件发生。

Acupuncture accelerates recovery after general anesthesia: a prospective randomized controlled trial

BACKGROUND： Acupuncture anesthesia was created in the 1950＇s in China and continues to be used there today during most major surgeries. It is widely used in China for such complex operations as brain heart, and abdominal surgery. It is popular in China because it is economical, practical, and beneficial to the patients. With acupuncture anesthesia there is less bleeding during surgery and there is also quicker post-operative recovery. OBJECTIVE： This randomized prospective study aims at comparing the effect of two acupoints （Yongquan, KI1 and Renzhong, DU26） with sham acupuncture and no acupuncture on the time to recovery of consciousness after general anesthesia by means of the Bispectral Index monitor （BIS） DESIGN, SETTING, PARTICIPANTS AND INTERVENTIONS： This is a prospective randomized controlled study. We randomly assigned 50 patients to 5 groups during recovery from surgical anesthesia. Four groups had acupuncture on KI1 （group A）, DU26 （groups B）, both KI1 and DU26 （group C）, and sham points （group D）, and one had no acupuncture （group E）. MAIN OUTCOME MEASURES： Bispectral Index （BIS）, time to spontaneous eye opening, time to tracheal extubation, and time to following commands were measured as the main outcome measures RESULTS： Time to spontaneous eye opening differed among groups （P=0.002）, as well as time to tracheal extubation （P〈0.000 1） and time to following commands （P=0.000 6）. BIS values differed significantly among groups both 5 and 10 min after the end of anesthesia （P〈0.000 1 and P=0.000 4, respectively）. BIS values of groups D and E were lower than those of the other groups and those of group C were higher. The same pattern was observed also 15 and 30 rain after the end of anesthesia although the difference among groups was not significant at these time points （P=0.164 and P=0.104 respectively）. CONCLUSION： Acupuncture on DU26 and KI 1 accelerates recovery of consciousness after general anesthesia. Moreover, a possible synergistic effect of DU26 and KI1 is suggested. This issue may play a role in the optimization of operating room management and raise interest about the usefulness of acupuncture on unconsciousness states of different nature.

前馈控制护理在腰突手术全麻复苏中的应用

目的:探讨前馈控制的麻醉恢复室全麻复苏护理在腰椎间盘突出症手术患者中的应用效果。方法:收集在某院接受腰椎间盘突出症手术治疗的85例患者的临床资料。根据护理方法的不同,将患者分为接受常规全麻复苏护理的对照组(46例)和接受前馈控制的全麻复苏护理的观察组(39例)。比较两组患者的术后躁动发生率、不良反应发生率以及麻醉复苏相关指标。结果:观察组患者的术后躁动发生率显著低于对照组(P<0.05),患者的不良事件发生率低于对照组(P<0.05)。同时,观察组患者的拔管时间、麻醉恢复室停留时长及完全苏醒时间均显著短于对照组,差异均具有统计学意义(P<0.05)。结论:前馈控制的麻醉恢复室全麻复苏护理策略能有效预防腰椎间盘突出症手术患者的术后躁动现象,减少不良事件的发生,并促进患者的快速麻醉复苏。

Effect of acupoint massage plus acupoint sticking therapy for the stress reaction during postoperative anesthesia recovery period in patients undergoing nasal endoscopic surgery

Objective:To observe the effect of acupoint massage plus acupoint sticking therapy for the stress reaction during postoperative anesthesia recovery period in patients undergoing nasal endoscopic surgery.Methods:A total of 120 patients undergoing nasal endoscopic surgery were included,and all patients were under trachea intubation and general anesthesia.The patients were randomized into an observation group and a control group,with 60 patients in each group.Patients in the control group received conventional anesthesia resuscitation,while patients in the observation group received acupoint massage plus acupoint sticking therapy on the basis of conventional anesthesia resuscitation.Changes in the heart rate (HR),systolic blood pressure (SBP) and diastolic blood pressure (DBP) were observed at three time points including the end of the surgery (TO),the removal of the tracheal tube (T1) and 10 min after the removal of the tracheal tube (T2).The awakening and tube removal time,choking cough and restlessness,and adverse reactions (dizziness,nausea and vomiting) in 24 h post-surgery period were compared.Results:At T1 and T2,the comparisons of HR,SBP and DBP between the two groups showed statistical significance (all P＜0.05).Intra-group comparisons showed that the HR,SBP and DBP of the control group at T1 and T2 were significant different from those at TO (all P＜0.05).There were significant differences in the awakening time and tube removal time between the two groups (both P＜0.05).The incidences of choking cough and restlessness were 8.3％ and 3.3％ respectively in the observation group,versus 53.3％ and 30.0％ in the control group,and the between-group comparisons showed statistical significance (both P＜0.05).The incidences of dizziness,nausea and vomiting in 24 h post-surgery period were 3.3％,5.0％ and 0.0％ respectively in the observation group,versus 43.3％,33.3％ and 25.0％ in the control group,and the between-group comparisons showed statistical significance (all P＜0.05).Conclusion:Acupoint massage plus acupoint sticking therapy can effectively regulate the stress reaction during postoperative anesthesia recovery period in patients undergoing nasal endoscopic surgery,and maintain a stable internal environment.

Role of T-type Calcium Channels in Generating Hyperexcitatory Behaviors during Emergence from Sevoflurane Anesthesia in Neonatal Rats

In the current study,we sought to investigate whether T-type Ca^(2+)channels(TCCs)in the brain are involved in generating post-anesthetic hyperexcitatory behaviors(PAHBs).We found that younger rat pups(postnatal days 9-11)had a higher incidence of PAHBs and higher PAHB scores than older pups(postnatal days16-18)during emergence from sevoflurane anesthesia.The power spectrum of the theta oscillations(4 Hz-8 Hz)in the prefrontal cortex was significantly enhanced in younger pups when PAHBs occurred,while there were no significant changes in older pups.Both the power of theta oscillations and the level of PAHBs were significantly reduced by the administration of TCC inhibitors.Moreover,the sensitivity of TCCs in the medial dorsal thalamic nucleus to sevoflurane was found to increase with age by investigating the kinetic properties of TCCs in vitro.TCCs were activated by potentiated GABAergic depolarization with a sub-anesthetic dose of sevoflurane(1%).These data suggest that(1)TCCs in the brain contribute to the generation of PAHBs and the concomitant electroencephalographic changes;(2)the stronger inhibitory effect of sevoflurane contributes to the lack of PAHBs in older rats;and(3)the contribution of TCCs to PAHBs is not mediated by a direct effect of sevoflurane on TCCs.

前馈控制护理干预对全麻手术患者苏醒期躁动及苏醒质量的临床效果

目的分析前馈控制护理干预对全麻手术患者苏醒期躁动及苏醒质量的影响。方法采取便利抽样法选取全麻手术患者118例,随机分为对照组和观察组,每组59例。对照组采取常规麻醉苏醒期护理干预,观察组采取前馈控制护理干预。比较2组患者苏醒期躁动发生情况、苏醒质量、疼痛情况及护理质量。结果观察组苏醒期躁动发生率为42.37%,低于对照组的69.49%,且观察组Richmond镇静躁动评估量表(RASS)评分、躁动持续时间及躁动次数分别低于、短于及少于对照组,差异有统计学意义(P<0.05):观察组自主呼吸恢复时间、睁眼时间、拔管时间、清醒时间及复苏室停留时间均短于对照组,且观察组Steward苏醒评分高于对照组,差异有统计学意义(P<0.05):观察组术后疼痛评分低于对照组,护理质量得分高于对照组,差异有统计学意义(P<0.05)。结论前馈控制护理干预能减少全麻手术患者苏醒期躁动发生,提高苏醒质量,减轻患者术后疼痛,提高护理质量。

单侧乳腺癌改良根治术患者采用右美托咪定麻醉的临床价值

目的:明确右美托咪定应用于单侧乳腺癌改良根治术患者临床麻醉的价值。方法:将本院120例单侧乳腺癌改良根治术患者采用计算机随机均分为观察组(n=60)和对照组(n=60);观察组在常规麻醉方案基础上应用右美托咪定,对照组应用常规麻醉方案;对两组患者的临床麻醉效果、麻醉苏醒期躁动及血流动力学指标进行比较。结果:两组比较,患者手术时间无统计学差异(P>0.05),观察组术后(2 h、8 h)镇静Ramsay评分低(P<0.05),术后清醒时间、拔管时间少(P<0.05),躁动分级评分、SAS评分低(P<0.05);麻醉前,两组SBP、DBP、HR、SpO 2数据无统计学差异(P>0.05);拔管时,观察组SBP、DBP和HR均明显低于后者、SpO 2高于后者(P<0.05)。结论:单侧乳腺癌改良根治术患者采用右美托咪定具有良好的麻醉效果,有助于减少患者麻醉苏醒期躁动,改善血流动力学情况。

小儿全身麻醉苏醒期躁动的危险因素分析

【目的】探讨小儿手术患者全身麻醉苏醒期躁动的危险因素。【方法】选择小儿全身麻醉患者410例,按照镇静躁动分级法对其苏醒状况进行评分,排除4分以下的患儿,对余下165例患儿的相关病史及麻醉病历分别作单因素和多因素logistic回归分析,评价小儿全身麻醉苏醒期躁动相关危险因素。【结果】单因素分析发现:手术史、手术大小、术后疼痛、麻醉维持方式、右美托咪啶、氯胺酮、曲马多、术后镇痛与躁动的发生相关(P<0.05)。多因素分析发现:年龄、术前焦虑、手术大小、术后疼痛、麻醉维持方式、右美托咪啶、留置尿管、术后镇痛等与躁动发生相关(P<0.05)。性别、性格、留置胃管、中心静脉置管、手术时间、拮抗、吸痰和腹腔镜手术与躁动发生无关(P>0.05)。【结论】小儿麻醉患者中学龄前儿童、术前焦虑、中等以上手术、全凭七氟醚吸入麻醉维持、留置尿管及术后疼痛患儿的术后躁动发生率显著增高。

右美托咪定对妇科腹腔镜手术患者麻醉恢复的影响

目的评价右美托咪定对妇科腹腔镜手术患者麻醉恢复的影响。方法妇科腹腔镜手术患者60例,随机均分为三组。D1、D2组术毕前30min分别给予右美托咪定0.4、0.8μg/kg,C组患者给予等量生理盐水。患者均采用静-吸复合麻醉。记录患者入室时(T0)、苏醒时(T1)、拔管时(T2)和离开PACU时(T3)的HR和MAP。记录苏醒时间、拔管时间和离开PACU时间,以及苏醒和拔管时Ramsay镇静评分和Riker躁动评分,术后呕吐、寒战等不良反应,追加芬太尼的例数。结果 D1、D2组拔管时间明显短于C组(P<0.05)。D2组患者恢复期追加芬太尼例数明显少于C组(P<0.05)。苏醒时D2组Ramsay评分明显高于C组和D1组(P<0.05),Riker评分明显低于C组和D1组(P<0.05)。与T0时比较,T1、T2时C组HR明显增快(P<0.05);T2时D1组HR明显增快(P<0.05);D2组HR变化差异无统计学意义;T2时C组MAP显著升高(P<0.05),且C组和D1组明显高于D2组(P<0.05);D2组MAP变化差异无统计学意义。结论妇科腹腔镜手术结束前30min给予右美托咪定0.8μg/kg可减少术后躁动,血流动力学稳定,不影响恢复时间。

右美托咪啶对腹腔镜胆囊切除术患者七氟烷麻醉复苏期躁动的影响

目的观察右美托咪定对腹腔镜胆囊切除术(LC)患者七氟烷麻醉复苏期躁动的影响。方法全身麻醉下行择期LC术90例,年龄20~78岁,ASA分级Ⅰ、Ⅱ级。采用随机数字表法,将其随机分为3组(n=30):七氟烷组(S组)、七氟烷+舒芬太尼组(SS组)和七氟烷+右美托咪定组(SD组)。3组患者术中维持七氟烷呼气末浓度1.3 MAC^1.5 MAC,3组患者缝合皮肤时停止吸入七氟烷,SS组缝合皮肤时手术结束前10 min静脉缓慢注射舒芬太尼0.15μg/kg,SD组手术开始气腹时静脉输注右美托咪定0.5μg/kg,输注时间为10min。S组为空白对照组。观察并记录3组患者手术结束前5 min(T0)、全身麻醉苏醒拔管前(T1)、拔管后即刻(T2)和拔管后5 min(T3)的SBP、HR、SPO2及躁动评分和视觉模拟评分(VAS)。结果与S组和SS组比较,SD组全身麻醉苏醒期SBP、HR明显降低,但与T0时段比较无明显差异或降低,而S组和SS组在T1、T2、T3时段SBP、HR均明显升高;与S组比较,SS组和SD组苏醒期躁动分级评分和躁动发生率明显降低(P<0.05或P<0.01),疼痛评分VAS临床评定优良率显著优于S组(P<0.01);但VAS评分SD组均明显优于SS组(P<0.05)。结论右美托咪定可有效减轻七氟烷麻醉复苏期躁动和心血管应激反应,有利于血流动力学稳定,并可提高LC术后患者苏醒期舒适度。

帕瑞昔布钠术前镇痛对瑞芬太尼快通道麻醉患者术后苏醒期的影响

目的探讨术前给予帕瑞昔布钠对瑞芬太尼快通道麻醉行腹腔镜胆囊切除术后苏醒期的影响。方法择期行腹腔镜胆囊切除术患者64例,随机均分为两组,术前20min分别静注帕瑞昔布钠40mg(P组)或等量生理盐水2ml(C组)。术中持续泵注丙泊酚和瑞芬太尼维持麻醉。记录自主呼吸恢复时间、睫毛反射时间、睁眼时间、拔管时间;记录拔管后患者疼痛VAS评分、Ramsay镇静评分和躁动情况。结果两组患者的自主呼吸恢复时间、睫毛反射时间、睁眼时间、拔管时间差异无统计学意义。与C组比较,拔管后10、30、60 min P组疼痛VAS评分、躁动评分明显降低,Ramsay镇静评分明显升高(P<0.05)。结论帕瑞昔布钠能较好地减轻快通道麻醉清醒期的躁动和疼痛,明显改善患者的血流动力学和应激反应,不良反应少,提高患者苏醒期的安全性。