癫痫手术后全身麻醉的苏醒模式:一项观察性试点研究

Lashmi Venkatraghavan, Suparna Bhardwaj, Sujoy Banik, Tumul Chowdhury, Mary Pat McAndrews, Taufik Valiante
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摘要

【摘要】目的麻醉苏醒从边缘结构开始,向外扩散到脑干、网状激活系统,再到皮层。癫痫手术通常包括切除边缘结构,因此可能会破坏出现的模式。本研究的目的是探讨癫痫手术后麻醉苏醒模式,并确定影响苏醒模式的相关变量。设置与设计三级保健中心,前瞻性观察研究。材料与方法对成人癫痫患者行颞叶前切除术和杏仁海马体切除术进行前瞻性观察。所有患者的麻醉管理都是标准化的,并允许他们在“无触摸”技术下醒来。研究的主要结局是麻醉后苏醒的模式(正常苏醒、激动苏醒或缓慢苏醒)。次要结果是探讨术前神经心理特征和边缘结构体积在不同出现模式之间的差异。定量变量分析采用Student's t检验。质变量分析采用卡方检验。结果29例患者完成了研究,其中9例(31%)出现激动出现,20例出现正常出现。在激越性出现中,2例患者Riker评分为7分,为暴力出现。患者的人口统计学、使用的麻醉剂、神经心理特征和边缘结构体积在正常急救组和激动急救组之间相似。然而,两名患有严重躁动(Riker量表为7)的患者智商最低。结论我们的初步研究表明突发性躁动在癫痫手术患者中并不罕见。然而,由于样本量较小,术前神经心理状况和海马体积在预测出现模式中的作用尚不确定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Emergence Patterns from General Anesthesia after Epilepsy Surgery: An Observational Pilot Study
Abstract Objective Emergence from anesthesia starts from the limbic structures and then spreads outwards to brainstem, reticular activating systems, and then to the cortex. Epilepsy surgery often involves resection of limbic structures and hence may disrupt the pattern of emergence. The aim of this study was to explore the pattern of emergence from anesthesia following epilepsy surgery and to determine associated variables affecting the emergence pattern. Setting and Design Tertiary care center, prospective observational study. Materials and Methods We conducted a prospective observation pilot study on adult patients undergoing anterior temporal lobectomy and amygdalohippocampectomy for epilepsy. Anesthesia management was standardized in all patients, and they were allowed to wake up with “no touch” technique. Primary outcome of the study was the pattern of emergence (normal emergence, agitated emergence, or slow emergence) from anesthesia. Secondary outcomes were to explore the differences in preoperative neuropsychological profile and limbic structure volumes between the different patterns of emergence. Quantitative variables were analyzed using Student's t-test. Qualitative variables were analyzed using chi-square test. Results Twenty-nine patients completed the study: 9 patients (31%) had agitated emergence, and 20 patients had normal emergence. Among the agitated emergence, 2 patients had Riker scale of 7 indicating violent emergence. Patient demographics, anesthetic used, neuropsychological profile, and limbic structure volumes were similar between normal emergence and agitated emergence groups. However, two patients who had severe agitation (Riker scale of 7) had the lowest intelligence quotient. Conclusion Our pilot study showed that emergence agitation is not uncommon in patients undergoing epilepsy surgery. However, due to smaller sample size, the role of preoperative neuropsychologic profile and hippocampal volumes in predicting the pattern of emergence is inconclusive.
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