Abstract:
Emergence delirium remains a clinically significant issue, which often leads to distress among pediatric patients, parents, and staff in the short term; and may also result in postoperative maladaptive behaviors persisting for weeks to months. Although several diagnostic tools are available, the Pediatric Anesthesia Emergence Delirium Scale is most often utilized. Many risk factors contributing to the likelihood of a pediatric patient developing emergence delirium have been identified; however, its accurate prediction remains challenging. Recently, intraoperative electroencephalographic monitoring has been used to improve the prediction of emergence delirium. Similarly, it may also prevent emergence delirium if the anesthesiologist ensures that the at-risk patient rouses only after the onset of appropriate electroencephalogram patterns, thus indicating a change to natural sleep. Prediction of at-risk patients is crucial; preventing emergence delirium may begin early during patient preparation by using non-pharmacological methods (i.e., the ADVANCE program). Intraoperative electroencephalographic monitoring can predict emergence delirium. This review also discusses a range of pharmacological treatment options which may assist the anesthesiologist in preventing emergence delirium among at-risk patients.
摘要:
出现谵妄仍然是一个临床上重要的问题,这通常会导致儿科患者的痛苦,父母,和工作人员在短期内;也可能导致术后适应不良行为持续数周至数月。尽管有几种诊断工具可用,小儿麻醉发生谵妄量表是最常用的。已经确定了许多导致儿科患者出现谵妄的风险因素;然而,它的准确预测仍然具有挑战性。最近,术中脑电图监测已被用来提高对出现谵妄的预测。同样,如果麻醉师确保有风险的患者仅在适当的脑电图模式开始后才苏醒,它也可以防止出现谵妄,因此表明自然睡眠的变化。预测有风险的患者至关重要;通过使用非药物方法(即,提前计划)。术中脑电图监测可以预测谵妄的发生。这篇综述还讨论了一系列药物治疗方案,这些方案可以帮助麻醉师预防高危患者出现谵妄。