小兒七氟烷麻醉后蘇醒期躁動的管理及護理要點_West China Medical Journal

Authors：

肖乾慧 , 熊際月 ,  劉娟

四川大學華西醫院麻醉科（成都 610041）;

Corresponding?author：

劉娟, Email: 18949672@qq.com

Keywords：

七氟烷; 全身麻醉; 蘇醒期躁動; 小兒

DOI：

10.7507/1002-0179.201602169

Video：

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七氟烷作為一種無刺激味、氣道刺激性小，尤其是誘導迅速、蘇醒快、呼吸抑制弱的吸入麻醉藥，目前已成為各類小兒外科手術全身麻醉誘導和維持的主要藥物。但七氟烷全身麻醉蘇醒期躁動的發生率顯著高于靜脈麻醉藥。七氟醚麻醉后的蘇醒期，即使無疼痛等其他刺激，部分患者也會出現躁動、興奮。七氟醚麻醉后蘇醒期躁動的發生率為 10%～67%，以學齡前兒童發生率最高。為防治這種現象，臨床使用咪達唑侖、丙泊酚等藥物，不僅可能出現呼吸抑制、缺氧等不良事件，同時會明顯延長患兒在麻醉蘇醒室（postanesthesia care unit，PACU）內的停留時間，增加醫療成本，對手術效果、PACU 醫護人員配備、家長的滿意度甚至患兒自身安全等都帶來了嚴重的影響，所以七氟烷麻醉后蘇醒期躁動是小兒麻醉醫生及 PACU 醫護人員最為關注的臨床事件之一。為了提高小兒麻醉質量，該文系統回顧了小兒七氟烷全身麻醉蘇醒期躁動的評估、病因、管理護理以及合理干預措施。

Citation： 肖乾慧, 熊際月, 劉娟. 小兒七氟烷麻醉后蘇醒期躁動的管理及護理要點. West China Medical Journal, 2017, 32(5): 777-781. doi: 10.7507/1002-0179.201602169 Copy

1.	?Lapin SL, Auden SM, Goldsmith LJ, et al. Effects of sevoflurane anaesthesia on recovery in children: a comparison with halothane. Paediatr Anaesth, 1999, 9(4): 299-304.
2.	Welborn LG, Hannallah RS, Norden JM, et al. Comparison of emergence and recovery characteristics of sevoflurane, desflurane, and halothane in pediatric ambulatory patients. Anesth Analg, 1996, 83(5): 917-920.
3.	Eckenhoff JE, Kneale DH, Dripps RD. The incidence and etiology of postanesthetic excitement. A clinical survey. Anesthesiology, 1961, 22: 667-673.
4.	Cole JW, Murray DJ, Mcallister JD, et al. Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesia. Paediatr Anaesth, 2002, 12(5): 442-447.
5.	Lerman J. Inhalational anesthetics. Paediatr Anaesth, 2004, 14(5): 380-383.
6.	Aono J, Ueda W, Mamiya K, et al. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology, 1997, 87(6): 1298-1300.
7.	Przybylo HJ, Martini DR, Mazurek AJ, et al. Assessing behaviour in children emerging from anaesthesia: can we apply psychiatric diagnostic techniques? Paediatr Anaesth 2003, 13(7): 609-616.
8.	Aono J, Mamiya K, Manabe M. Preoperative anxiety is associated with a high incidence of problematic behavior on emergence after halothane anesthesia in boys. Acta Anaesthesiol Scand, 1999, 43(5): 542-544.
9.	Weldon BC, Bell M, Craddock T. The effect of caudal analgesia on emergence agitation in children after sevofluraneversus halothane anesthesia. Anesth Analg, 2004, 98(2): 321-326, table of contents.
10.	Kain ZN, Caldwell-Andrews AA, Maranets I, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg, 2004, 99(6): 1648-1654, table of contents.
11.	Kain ZN, Mayes LC, Wang SM, et al. Postoperative behavioral outcomes in children: effects of sedative premedication. Anesthesiology, 1999, 90(3): 758-765.
12.	Arai YC, Fukunaga K, Hirota S. Comparison of a combination of midazolam and diazepam and midazolam alone as oral premedication on preanesthetic and emergence condition in children. Acta Anaesthesiol Scand, 2005, 49(5): 698-701.
13.	Cohen IT, Drewsen S, Hannallah RS. Propofol or midazolam do not reduce the incidence of emergence agitation associated with desflurane anaesthesia in children undergoing adenotonsillectomy. Paediatr Anaesth, 2002, 12(7): 604-609.
14.	Samarkandi A, Naguib M, Riad W, et al. Melatoninvs. midazolam premedication in children: a double-blind, placebo-controlled study. Eur J Anaesthesiol, 2005, 22(3): 189-196.
15.	Kararmaz A, Kaya S, Turhanoglu S, et al. Oral ketamine premedication can prevent emergence agitation in children after desflurane anaesthesia. Paediatr Anaesth, 2004, 14(6): 477-482.
16.	Murray DJ, Cole JW, Shrock CD, et al. Sevofluraneversus halothane: effect of oxycodone premedication on emergence behaviour in children. Paediatr Anaesth, 2002, 12(4): 308-312.
17.	Beskow A, Westrin P. Sevoflurane causes more postoperative agitation in children than does halothane. Acta Anaesthesiol Scand, 1999, 43(5): 536-541.
18.	Cravero JP, Beach M, Dodge CP, et al. Emergence characteristics of sevoflurane compared to halothane in pediatric patients undergoing bilateral pressure equalization tube insertion. J Clin Anesth, 2000, 12(5): 397-401.
19.	Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: a comparison with halothane. Paediatr Anaesth, 2000, 10(4): 419-424.
20.	Kain ZN, Caldwell-Andrews AA, Weinberg ME, et al. Sevoflurane versus halothane: postoperative maladaptive behavioral changes: a randomized, controlled trial. Anesthesiology, 2005, 102(4): 720-726.
21.	Cohen IT, Hannallah RS, Hummer KA. The incidence of emergence agitation associated with desflurane anesthesia in children is reduced by fentanyl. Anesth Analg, 2001, 93(1): 88-91.
22.	Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg, 2003, 96(6): 1625-1630.
23.	Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevofluraneversus propofol. Acta Anaesthesiol Scand, 2000, 44(3): 307-310.
24.	Uezono S, Goto T, Terui K, et al. Emergence agitation after sevofluraneversus propofol in pediatric patients. Anesth Analg, 2000, 91(3): 563-566.
25.	Cohen IT, Finkel JC, Hannallah RS, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13(1): 63-67.
26.	Oh AY, Seo KS, Kim CS, et al. Delayed emergence process does not result in a lower incidence of emergence agitation after sevoflurane anesthesia in children. Acta Anaesthesiol Scand, 2005, 49(3): 297-299.
27.	Shibata S, Shigeomi S, Sato W, et al. Nitrous oxide administration during washout of sevoflurane improves postanesthetic agitation in children. J Anesth, 2005, 19(2): 160-163.
28.	Moos DD. Sevoflurane and emergence behavioral changes in pediatrics. J PeriAnesth Nurs 2005, 20(1): 13-18.
29.	Finkel JC, Cohen IT, Hannallah RS, et al. The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement. Anesth Analg, 2001, 92(5): 1164-1168.
30.	Cravero JP, Beach M, Thyr B, et al. The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Anesth Analg, 2003, 97(2): 364-367, table of contents.
31.	Demirbilek S, Togal T, Cicek M, et al. Effects of fentanyl on the incidence of emergence agitation in children receiving desflurane or sevoflurane anaesthesia. Eur J Anaesthesiol, 2004, 21(7): 538-542.
32.	Kulka PJ, Bressem M, Tryba M. Clonidine prevents sevoflurane-induced agitation in children. Anesth Analg, 2001, 93(2): 335-338, 2nd contents page.
33.	Bock M, Kunz P, Schreckenberger R, et al. Comparison of caudal and intravenous clonidine in the prevention of agitation after sevoflurane in children. Br J Anaesth, 2002, 88(6): 790-796.
34.	Manworren RC, Paulos CL, Pop R. Treating children for acute agitation in the PACU: differentiating pain and emergence delirium. J Perianesth Nurs, 2004, 19(3): 183-193.
35.	Keaney A, Diviney D, Harte S, et al. Postoperative behavioral changes following anesthesia with sevoflurane. Paediatr Anaesth, 2004, 14(10): 866-870.

1. ?Lapin SL, Auden SM, Goldsmith LJ, et al. Effects of sevoflurane anaesthesia on recovery in children: a comparison with halothane. Paediatr Anaesth, 1999, 9(4): 299-304.
2. Welborn LG, Hannallah RS, Norden JM, et al. Comparison of emergence and recovery characteristics of sevoflurane, desflurane, and halothane in pediatric ambulatory patients. Anesth Analg, 1996, 83(5): 917-920.
3. Eckenhoff JE, Kneale DH, Dripps RD. The incidence and etiology of postanesthetic excitement. A clinical survey. Anesthesiology, 1961, 22: 667-673.
4. Cole JW, Murray DJ, Mcallister JD, et al. Emergence behaviour in children: defining the incidence of excitement and agitation following anaesthesia. Paediatr Anaesth, 2002, 12(5): 442-447.
5. Lerman J. Inhalational anesthetics. Paediatr Anaesth, 2004, 14(5): 380-383.
6. Aono J, Ueda W, Mamiya K, et al. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology, 1997, 87(6): 1298-1300.
7. Przybylo HJ, Martini DR, Mazurek AJ, et al. Assessing behaviour in children emerging from anaesthesia: can we apply psychiatric diagnostic techniques? Paediatr Anaesth 2003, 13(7): 609-616.
8. Aono J, Mamiya K, Manabe M. Preoperative anxiety is associated with a high incidence of problematic behavior on emergence after halothane anesthesia in boys. Acta Anaesthesiol Scand, 1999, 43(5): 542-544.
9. Weldon BC, Bell M, Craddock T. The effect of caudal analgesia on emergence agitation in children after sevofluraneversus halothane anesthesia. Anesth Analg, 2004, 98(2): 321-326, table of contents.
10. Kain ZN, Caldwell-Andrews AA, Maranets I, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg, 2004, 99(6): 1648-1654, table of contents.
11. Kain ZN, Mayes LC, Wang SM, et al. Postoperative behavioral outcomes in children: effects of sedative premedication. Anesthesiology, 1999, 90(3): 758-765.
12. Arai YC, Fukunaga K, Hirota S. Comparison of a combination of midazolam and diazepam and midazolam alone as oral premedication on preanesthetic and emergence condition in children. Acta Anaesthesiol Scand, 2005, 49(5): 698-701.
13. Cohen IT, Drewsen S, Hannallah RS. Propofol or midazolam do not reduce the incidence of emergence agitation associated with desflurane anaesthesia in children undergoing adenotonsillectomy. Paediatr Anaesth, 2002, 12(7): 604-609.
14. Samarkandi A, Naguib M, Riad W, et al. Melatoninvs. midazolam premedication in children: a double-blind, placebo-controlled study. Eur J Anaesthesiol, 2005, 22(3): 189-196.
15. Kararmaz A, Kaya S, Turhanoglu S, et al. Oral ketamine premedication can prevent emergence agitation in children after desflurane anaesthesia. Paediatr Anaesth, 2004, 14(6): 477-482.
16. Murray DJ, Cole JW, Shrock CD, et al. Sevofluraneversus halothane: effect of oxycodone premedication on emergence behaviour in children. Paediatr Anaesth, 2002, 12(4): 308-312.
17. Beskow A, Westrin P. Sevoflurane causes more postoperative agitation in children than does halothane. Acta Anaesthesiol Scand, 1999, 43(5): 536-541.
18. Cravero JP, Beach M, Dodge CP, et al. Emergence characteristics of sevoflurane compared to halothane in pediatric patients undergoing bilateral pressure equalization tube insertion. J Clin Anesth, 2000, 12(5): 397-401.
19. Cravero J, Surgenor S, Whalen K. Emergence agitation in paediatric patients after sevoflurane anaesthesia and no surgery: a comparison with halothane. Paediatr Anaesth, 2000, 10(4): 419-424.
20. Kain ZN, Caldwell-Andrews AA, Weinberg ME, et al. Sevoflurane versus halothane: postoperative maladaptive behavioral changes: a randomized, controlled trial. Anesthesiology, 2005, 102(4): 720-726.
21. Cohen IT, Hannallah RS, Hummer KA. The incidence of emergence agitation associated with desflurane anesthesia in children is reduced by fentanyl. Anesth Analg, 2001, 93(1): 88-91.
22. Voepel-Lewis T, Malviya S, Tait AR. A prospective cohort study of emergence agitation in the pediatric postanesthesia care unit. Anesth Analg, 2003, 96(6): 1625-1630.
23. Picard V, Dumont L, Pellegrini M. Quality of recovery in children: sevofluraneversus propofol. Acta Anaesthesiol Scand, 2000, 44(3): 307-310.
24. Uezono S, Goto T, Terui K, et al. Emergence agitation after sevofluraneversus propofol in pediatric patients. Anesth Analg, 2000, 91(3): 563-566.
25. Cohen IT, Finkel JC, Hannallah RS, et al. Rapid emergence does not explain agitation following sevoflurane anaesthesia in infants and children: a comparison with propofol. Paediatr Anaesth, 2003, 13(1): 63-67.
26. Oh AY, Seo KS, Kim CS, et al. Delayed emergence process does not result in a lower incidence of emergence agitation after sevoflurane anesthesia in children. Acta Anaesthesiol Scand, 2005, 49(3): 297-299.
27. Shibata S, Shigeomi S, Sato W, et al. Nitrous oxide administration during washout of sevoflurane improves postanesthetic agitation in children. J Anesth, 2005, 19(2): 160-163.
28. Moos DD. Sevoflurane and emergence behavioral changes in pediatrics. J PeriAnesth Nurs 2005, 20(1): 13-18.
29. Finkel JC, Cohen IT, Hannallah RS, et al. The effect of intranasal fentanyl on the emergence characteristics after sevoflurane anesthesia in children undergoing surgery for bilateral myringotomy tube placement. Anesth Analg, 2001, 92(5): 1164-1168.
30. Cravero JP, Beach M, Thyr B, et al. The effect of small dose fentanyl on the emergence characteristics of pediatric patients after sevoflurane anesthesia without surgery. Anesth Analg, 2003, 97(2): 364-367, table of contents.
31. Demirbilek S, Togal T, Cicek M, et al. Effects of fentanyl on the incidence of emergence agitation in children receiving desflurane or sevoflurane anaesthesia. Eur J Anaesthesiol, 2004, 21(7): 538-542.
32. Kulka PJ, Bressem M, Tryba M. Clonidine prevents sevoflurane-induced agitation in children. Anesth Analg, 2001, 93(2): 335-338, 2nd contents page.
33. Bock M, Kunz P, Schreckenberger R, et al. Comparison of caudal and intravenous clonidine in the prevention of agitation after sevoflurane in children. Br J Anaesth, 2002, 88(6): 790-796.
34. Manworren RC, Paulos CL, Pop R. Treating children for acute agitation in the PACU: differentiating pain and emergence delirium. J Perianesth Nurs, 2004, 19(3): 183-193.
35. Keaney A, Diviney D, Harte S, et al. Postoperative behavioral changes following anesthesia with sevoflurane. Paediatr Anaesth, 2004, 14(10): 866-870.

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小兒七氟烷麻醉后蘇醒期躁動的管理及護理要點

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