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Abstract：
OBJECTIVE: Emergence agitation (EA) after general anesthesia is common in patients with post-traumatic stress disorder (PTSD). Due to the recent worldwide events such as the Covid-19 pandemic and wars, PTSD is not rare. Accordingly, a reliable, cost-effective anesthetic protocol to lower the incidence of EA is crucial. Therefore, we aimed to compare three different interventions for avoiding EA in PTSD patients undergoing gynecological laparoscopic surgery. Participants were divided into four groups: 1: performing pre-operative relaxation techniques (deep breathing exercise and progressive muscle relaxation [PMR]); 2: administrating intra-operative Ketamine; 3: applying both previously mentioned strategies and 4 as controls.
METHODS: This study was carried out on 144 adult women scheduled for gynecological laparoscopy, randomly allocated into four groups: three intervention groups and a control group (36 each). Women aged 18-45 years old, with a diagnosis of PTSD were included in the study. Patients with a positive history of major neurological, cardiovascular, metabolic, respiratory, or renal disease were excluded. Any patient who reported the use of psychiatric drugs were also excluded from the study. Data was analyzed using IBM SPSS Statistics software version 26. Kolmogorov- Smirnov was used to verify the normality of the distribution of variables. Odds ratio was calculated to clarify the strength and direction of the association between intervention groups and control. Data was deemed significant at a p-value ≤0.05.
RESULTS: Heart rate (HR) and Mean Arterial Blood Pressure (MABP) intra-operative and post-operative till 24 hours were significantly lower in groups 1, 2, and 3 compared to group 4 (p<0.001). There was a significant statistical difference in the intraoperative HR percentage decrease. MABP percentage decrease post-operative was higher in all the intervention groups with no statistically significant difference, except for group 1 compared to group 4, which was statistically significant (12.28 ± 11.77 and 6.10 ± 7.24, p=0.025). Visual Analogue Scale measurements were significantly less in the intervention groups 1, 2, and 3 compared to group 4. On Riker sedation-agitation scores, group 1 was 85 times more likely to be non-agitated (85 (15.938 - 453.307), p<0.001), group 2 was 175 times more likely to be non-agitated (175 (19.932-1536.448), p<0.001) and group 3 was protected against agitation.
CONCLUSIONS: Pre-operative relaxation techniques (breathing exercises and PMR) significantly lowered HR, MABP, VAS score, and EA than controls. These effects were not significantly different from intra-operative ketamine injection or the combination of both (relaxation techniques and ketamine). We recommend routine pre-operative screening for PTSD and the application of relaxation techniques (breathing exercises and PMR) in the pre-operative preparation protocol of PTSD-positive cases as well as routine practical application of preoperative relaxation techniques. Further studies on using pre-operative relaxation techniques in general could be cost-effective.
METHODS: This study was carried out on 144 adult women scheduled for gynecological laparoscopy, randomly allocated into four groups: three intervention groups and a control group (36 each). Women aged 18-45 years old, with a diagnosis of PTSD were included in the study. Patients with a positive history of major neurological, cardiovascular, metabolic, respiratory, or renal disease were excluded. Any patient who reported the use of psychiatric drugs were also excluded from the study. Data was analyzed using IBM SPSS Statistics software version 26. Kolmogorov- Smirnov was used to verify the normality of the distribution of variables. Odds ratio was calculated to clarify the strength and direction of the association between intervention groups and control. Data was deemed significant at a p-value ≤0.05.
RESULTS: Heart rate (HR) and Mean Arterial Blood Pressure (MABP) intra-operative and post-operative till 24 hours were significantly lower in groups 1, 2, and 3 compared to group 4 (p<0.001). There was a significant statistical difference in the intraoperative HR percentage decrease. MABP percentage decrease post-operative was higher in all the intervention groups with no statistically significant difference, except for group 1 compared to group 4, which was statistically significant (12.28 ± 11.77 and 6.10 ± 7.24, p=0.025). Visual Analogue Scale measurements were significantly less in the intervention groups 1, 2, and 3 compared to group 4. On Riker sedation-agitation scores, group 1 was 85 times more likely to be non-agitated (85 (15.938 - 453.307), p<0.001), group 2 was 175 times more likely to be non-agitated (175 (19.932-1536.448), p<0.001) and group 3 was protected against agitation.
CONCLUSIONS: Pre-operative relaxation techniques (breathing exercises and PMR) significantly lowered HR, MABP, VAS score, and EA than controls. These effects were not significantly different from intra-operative ketamine injection or the combination of both (relaxation techniques and ketamine). We recommend routine pre-operative screening for PTSD and the application of relaxation techniques (breathing exercises and PMR) in the pre-operative preparation protocol of PTSD-positive cases as well as routine practical application of preoperative relaxation techniques. Further studies on using pre-operative relaxation techniques in general could be cost-effective.
摘要：
目的：全身麻醉后躁动（EA）在创伤后应激障碍（PTSD）患者中很常见。由于最近的全球事件，如新冠肺炎大流行和战争，PTSD并不罕见。因此，一个可靠的，降低EA发生率的成本有效的麻醉方案至关重要.因此,我们的目的是比较三种不同的干预措施,以避免接受妇科腹腔镜手术的PTSD患者的EA.参与者分为四组：1：进行术前放松技术（深呼吸运动和渐进性肌肉放松[PMR]）；2：术中服用氯胺酮；3：应用上述两种策略，4作为对照。
方法：这项研究是对计划进行妇科腹腔镜检查的144名成年女性进行的，随机分为四组：三个干预组和对照组（每组36）。18-45岁的女性，诊断为PTSD的患者纳入研究.有重大神经系统病史的患者，心血管,新陈代谢，呼吸,或肾脏疾病被排除。任何报告使用精神科药物的患者也被排除在研究之外。使用IBMSPSSStatistics软件版本26分析数据。Kolmogorov-Smirnov用于验证变量分布的正态。计算赔率以阐明干预组和对照组之间关联的强度和方向。在p值≤0.05时，数据被认为是显著的。
结果：与第4组相比，第1、2和3组在术中和术后直到24小时的心率（HR）和平均动脉血压（MABP）均显着降低（p<0.001）。术中HR下降百分比有显著统计学差别。所有干预组术后MABP下降百分比均较高，差异无统计学意义。除了第1组比第4组有统计学意义(12.28±11.77和6.10±7.24,p=0.025)。与第4组相比，干预组1、2和3的视觉模拟量表测量值明显较少。关于Riker镇静-激动评分，第1组非激动的可能性是85倍(85(15.938-453.307)，p<0.001)，第2组是不激动的175倍(175(19.932-1536.448)，p<0.001），第3组不受搅动的影响。
结论：术前放松技术（呼吸练习和PMR）可显著降低HR，MABP,VAS评分,和EA比控制。这些效果与术中注射氯胺酮或两者的组合（松弛技术和氯胺酮）没有显着差异。我们建议对PTSD进行常规术前筛查，并在PTSD阳性病例的术前准备方案中应用放松技术（呼吸练习和PMR），以及术前放松技术的常规实际应用。通常，对使用术前放松技术的进一步研究可能具有成本效益。
方法：这项研究是对计划进行妇科腹腔镜检查的144名成年女性进行的，随机分为四组：三个干预组和对照组（每组36）。18-45岁的女性，诊断为PTSD的患者纳入研究.有重大神经系统病史的患者，心血管,新陈代谢，呼吸,或肾脏疾病被排除。任何报告使用精神科药物的患者也被排除在研究之外。使用IBMSPSSStatistics软件版本26分析数据。Kolmogorov-Smirnov用于验证变量分布的正态。计算赔率以阐明干预组和对照组之间关联的强度和方向。在p值≤0.05时，数据被认为是显著的。
结果：与第4组相比，第1、2和3组在术中和术后直到24小时的心率（HR）和平均动脉血压（MABP）均显着降低（p<0.001）。术中HR下降百分比有显著统计学差别。所有干预组术后MABP下降百分比均较高，差异无统计学意义。除了第1组比第4组有统计学意义(12.28±11.77和6.10±7.24,p=0.025)。与第4组相比，干预组1、2和3的视觉模拟量表测量值明显较少。关于Riker镇静-激动评分，第1组非激动的可能性是85倍(85(15.938-453.307)，p<0.001)，第2组是不激动的175倍(175(19.932-1536.448)，p<0.001），第3组不受搅动的影响。
结论：术前放松技术（呼吸练习和PMR）可显著降低HR，MABP,VAS评分,和EA比控制。这些效果与术中注射氯胺酮或两者的组合（松弛技术和氯胺酮）没有显着差异。我们建议对PTSD进行常规术前筛查，并在PTSD阳性病例的术前准备方案中应用放松技术（呼吸练习和PMR），以及术前放松技术的常规实际应用。通常，对使用术前放松技术的进一步研究可能具有成本效益。
