|
1
|
Meng T, Lin X, Li X, Yue F, Zhang Y, Wang Y, Gu J, Yang Z, Yu H, Lv K, Liang S, Li X, Zhu W, Yu G, Li T, Ren Y, Li Y, Xu J, Xu W, Wang S, Wu J. Pre-anesthetic use of butorphanol for the prevention of emergence agitation in thoracic surgery: A multicenter, randomized controlled trial. Front Med (Lausanne) 2022; 9:1040168. [PMID: 36582294 PMCID: PMC9792474 DOI: 10.3389/fmed.2022.1040168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Background Emergence agitation (EA) is common in patients after general anesthesia (GA) and is associated with poor outcomes. Patients with thoracic surgery have a higher incidence of EA compared with other surgery. This study aimed to investigate the impact of pre-anesthetic butorphanol infusion on the incidence of EA in patients undergoing thoracic surgery with GA. Materials and methods This prospective randomized controlled trial (RCT) was conducted in 20 tertiary hospitals in China. A total of 668 patients undergoing elective video-assisted thoracoscopic lobectomy/segmentectomy for lung cancer were assessed for eligibility, and 620 patients were enrolled. In total, 296 patients who received butorphanol and 306 control patients were included in the intention-to-treat analysis. Patients in the intervention group received butorphanol 0.02 mg/kg 15 min before induction of anesthesia. Patients in the control group received volume-matched normal saline in the same schedule. The primary outcome was the incidence of EA after 5 min of extubation, and EA was evaluated using the Riker Sedation-Agitation Scale (RSAS). The incidence of EA was determined by the chi-square test, with a significance of P < 0.05. Results In total, 296 patients who received butorphanol and 306 control patients were included in the intention-to-treat analysis. The incidence of EA 5 min after extubation was lower with butorphanol treatment: 9.8% (29 of 296) vs. 24.5% (75 of 306) in the control group (P = 0.0001). Patients who received butorphanol had a lower incidence of drug-related complications (including injecting propofol pain and coughing with sufentanil): 112 of 296 vs. 199 of 306 in the control group (P = 0.001) and 3 of 296 vs. 35 of 306 in the control group (P = 0.0001). Conclusion The pre-anesthetic administration of butorphanol reduced the incidence of EA after thoracic surgery under GA. Clinical trial registration [http://www.chictr.org.cn/showproj.aspx?proj=42684], identifier [ChiCTR1900025705].
Collapse
Affiliation(s)
- Tao Meng
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, China
| | - Xiaowen Lin
- Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Ximing Li
- Department of Anesthesiology, Linyi People’s Hospital, Linyi, China
| | - Fangli Yue
- Department of Anesthesiology, Weifang People’s Hospital, Weifang, China
| | - Yuzhu Zhang
- Department of Anesthesiology, Zibo Central Hospital, Zibo, China
| | - Yingbin Wang
- Department of Anesthesiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Jianhua Gu
- Department of Anesthesiology, Jinan People’s Hospital, Jinan, China
| | - Zaiqi Yang
- Department of Anesthesiology, Taian City Central Hospital, Taian, China
| | - Hongli Yu
- Department of Anesthesiology, Tianjin First Central Hospital, Tianjin, China
| | - Kun Lv
- Department of Anesthesiology, Jining No.1 People’s Hospital, Jining, China
| | - Shengyong Liang
- Department of Anesthesiology, Feicheng People’s Hospital, Feicheng, China
| | - Xingda Li
- Department of Anesthesiology, Linyi Central Hospital, Linyi, China
| | - Weibo Zhu
- Department of Anesthesiology, Binzhou People’s Hospital, Binzhou, China
| | - Gang Yu
- Department of Anesthesiology, Binzhou Central Hospital, Binzhou, China
| | - Tao Li
- Department of Anesthesiology, Yantai Yuhuangding Hospital, Yantai, China
| | - Yujia Ren
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yandong Li
- Department of Anesthesiology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Jianjun Xu
- Department of Anesthesiology, Daqing Oilfield General Hospital, Daqing, China
| | - Weimin Xu
- Department of Anesthesiology, Shengli Oilfield Central Hospital, Dongying, China
| | - Shu Wang
- Department of Anesthesiology, Benxi Central Hospital, Benxi, China
| | - Jianbo Wu
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, China,Department of Anesthesiology and Perioperative Medicine, Qilu Hospital Dezhou Hospital, Shandong University, Dezhou, China,*Correspondence: Jianbo Wu,
| |
Collapse
|
|
2
|
Yuan Y, Lei B, Li Z, Wang X, Zhao H, Gao M, Xue Y, Zhang W, Xiao R, Meng X, Zheng H, Zhang J, Wang G, Guo X. A Cross-Sectional Survey on the Clinical Management of Emergence Delirium in Adults: Knowledge, Attitudes, and Practice in Mainland China. Brain Sci 2022; 12:brainsci12080989. [PMID: 35892429 PMCID: PMC9332432 DOI: 10.3390/brainsci12080989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/24/2022] [Accepted: 07/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Emergence delirium (ED) occurs immediately after emergence from general anesthesia, which may have adverse consequences. This cross-sectional survey assessed Chinese physicians’ and nurses’ knowledge of, attitudes towards, and practice regarding ED in adults. Methods: Electronic questionnaires were sent to 93 major academic hospitals across mainland China and both attending anesthesiologists and anesthesia nurses were recommended to complete them. Results: A total of 243 anesthesiologists and 213 anesthesia nurses participated in the survey. Most of the participants considered it a very important issue; however, less than one-third of them routinely assessed ED. In terms of screening tools, anesthesiologists preferred the Confusion Assessment Method, while anesthesia nurses reported using multiple screening tools. Divergence also appeared with regard to the necessity of monitoring the depth of anesthesia. Anesthesiologists considered it only necessary in high-risk patients, while the nurses considered that it should be carried out routinely. No unified treatment strategy nor medication was reported for ED treatment during the recovery period. Conclusions: This study illustrated that there are high awareness levels among both Chinese anesthesiologists and anesthesia nurses regarding the importance of ED. However, a specific practice in terms of routine delirium assessment, anesthesia depth monitoring, and a standardized treatment algorithm needs to be implemented to improve ED management.
Collapse
Affiliation(s)
- Yi Yuan
- Department of Anesthesiology, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing 100035, China; (Y.Y.); (W.Z.); (R.X.); (X.M.)
| | - Bao Lei
- Department of Anesthesiology, The Yan’an Branch of Peking University Third Hospital, Yan’an Traditional Chinese Medicine Hospital, Yan’an 716000, China; (B.L.); (Z.L.); (H.Z.); (M.G.); (Y.X.)
| | - Zhengqian Li
- Department of Anesthesiology, The Yan’an Branch of Peking University Third Hospital, Yan’an Traditional Chinese Medicine Hospital, Yan’an 716000, China; (B.L.); (Z.L.); (H.Z.); (M.G.); (Y.X.)
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China
- Perioperative Medicine Branch of China International Exchange and Promotive Association for Medical and Health Care (CPAM), No. 49, North Garden Street, Haidian District, Beijing 100191, China; (H.Z.); (J.Z.)
| | - Xiaoxiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China;
| | - Huiling Zhao
- Department of Anesthesiology, The Yan’an Branch of Peking University Third Hospital, Yan’an Traditional Chinese Medicine Hospital, Yan’an 716000, China; (B.L.); (Z.L.); (H.Z.); (M.G.); (Y.X.)
| | - Meng Gao
- Department of Anesthesiology, The Yan’an Branch of Peking University Third Hospital, Yan’an Traditional Chinese Medicine Hospital, Yan’an 716000, China; (B.L.); (Z.L.); (H.Z.); (M.G.); (Y.X.)
| | - Yingying Xue
- Department of Anesthesiology, The Yan’an Branch of Peking University Third Hospital, Yan’an Traditional Chinese Medicine Hospital, Yan’an 716000, China; (B.L.); (Z.L.); (H.Z.); (M.G.); (Y.X.)
| | - Wenchao Zhang
- Department of Anesthesiology, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing 100035, China; (Y.Y.); (W.Z.); (R.X.); (X.M.)
| | - Rui Xiao
- Department of Anesthesiology, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing 100035, China; (Y.Y.); (W.Z.); (R.X.); (X.M.)
| | - Xue Meng
- Department of Anesthesiology, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing 100035, China; (Y.Y.); (W.Z.); (R.X.); (X.M.)
| | - Hongcai Zheng
- Perioperative Medicine Branch of China International Exchange and Promotive Association for Medical and Health Care (CPAM), No. 49, North Garden Street, Haidian District, Beijing 100191, China; (H.Z.); (J.Z.)
| | - Jing Zhang
- Perioperative Medicine Branch of China International Exchange and Promotive Association for Medical and Health Care (CPAM), No. 49, North Garden Street, Haidian District, Beijing 100191, China; (H.Z.); (J.Z.)
| | - Geng Wang
- Department of Anesthesiology, Beijing Jishuitan Hospital, No. 31, Xinjiekou East Street, Xicheng District, Beijing 100035, China; (Y.Y.); (W.Z.); (R.X.); (X.M.)
- Correspondence: (G.W.); (X.G.)
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, No. 49, North Garden Street, Haidian District, Beijing 100191, China
- Perioperative Medicine Branch of China International Exchange and Promotive Association for Medical and Health Care (CPAM), No. 49, North Garden Street, Haidian District, Beijing 100191, China; (H.Z.); (J.Z.)
- Correspondence: (G.W.); (X.G.)
| |
Collapse
|
|
3
|
Li Y, Li J, Shi Y, Zhou X, Feng W, Han L, Ma D, Jiang H, Yuan Y. Urinary Aromatic Amino Acid Metabolites Associated With Postoperative Emergence Agitation in Paediatric Patients After General Anaesthesia: Urine Metabolomics Study. Front Pharmacol 2022; 13:932776. [PMID: 35928271 PMCID: PMC9343964 DOI: 10.3389/fphar.2022.932776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Emergence agitation (EA) is very common in paediatric patients during recovery from general anaesthesia, but underlying mechanisms remain unknown. This prospective study was designed to profile preoperative urine metabolites and identify potential biomarkers that can predict the occurrence of EA. Methods: A total of 224 patients were screened for recruitment; of those, preoperative morning urine samples from 33 paediatric patients with EA and 33 non-EA gender- and age-matched patients after being given sevoflurane general anaesthesia were analysed by ultra-high-performance liquid chromatography (UHPLC) coupled with a Q Exactive Plus mass spectrometer. Univariate analysis and orthogonal projection to latent structures squares-discriminant analysis (OPLS-DA) were used to analyse these metabolites. The least absolute shrinkage and selection operator (LASSO) regression was used to identify predictive variables. The predictive model was evaluated through the receiver operating characteristic (ROC) analysis and then further assessed with 10-fold cross-validation. Results: Seventy-seven patients completed the study, of which 33 (42.9%) patients developed EA. EA and non-EA patients had many differences in preoperative urine metabolic profiling. Sixteen metabolites including nine aromatic amino acid metabolites, acylcarnitines, pyridoxamine, porphobilinogen, 7-methylxanthine, and 5′-methylthioadenosine were found associated with an increased risk of EA, and they all exhibited higher levels in the EA group than in the non-EA group. The main metabolic pathways involved in these metabolic changes included phenylalanine, tyrosine and tryptophan metabolisms. Among these potential biomarkers, L-tyrosine had the best predictive value with an odds ratio (OR) (95% CI) of 5.27 (2.20–12.63) and the AUC value of 0.81 (0.70–0.91) and was robust with internal 10-fold cross-validation. Conclusion: Urinary aromatic amino acid metabolites are closely associated with EA in paediatric patients, and further validation with larger cohorts and mechanistic studies is needed. Clinical Trial Registration:clinicaltrials.gov, identifier NCT04807998
Collapse
Affiliation(s)
- Yueyue Li
- Department of Pharmacy, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jingjie Li
- Department of Anaesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhuan Shi
- Department of Pharmacy, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xuhui Zhou
- Department of Anaesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanqing Feng
- Department of Anaesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Han
- Department of Pharmacy, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Daqing Ma
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Hong Jiang
- Department of Anaesthesiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Hong Jiang, ; Yongfang Yuan,
| | - Yongfang Yuan
- Department of Pharmacy, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
- *Correspondence: Hong Jiang, ; Yongfang Yuan,
| |
Collapse
|
|
4
|
Mi X, Hong J, Li Z, Liu T, Wang Q, Zhou J, Li Y, Wang X, Yuan Y, Yang N, Han Y, Zhou Y, Guo X, Li Y, Han D. Identification of Serum Biomarkers Associated With Emergence Agitation After General Anesthesia in Adult Patients: A Metabolomics Analysis. Front Med (Lausanne) 2022; 9:828867. [PMID: 35402462 PMCID: PMC8983911 DOI: 10.3389/fmed.2022.828867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background Emergence agitation (EA) is a conscious disturbance after general anesthesia in adult patients that can lead to severe respiratory or circulatory complications and serious physical injury to patients and caregivers. However, the pathophysiological mechanisms underlying EA remain unclear. The present study aimed to identify serum metabolites with significant alterations in EA patients after general anesthesia and enable inferences on their associations with EA. Methods EA patients were identified by Richmond Agitation-Sedation Scale (RASS) ≥ + 2 among a cohort of adult patients who received elective surgery under general anesthesia in Peking University Third Hospital between 01 June 2020 and 30 December 2020. We further selected sex-, age-, and surgery type-matched non-EA control patients at a 1:1.5 ratio. Postoperative serum samples were collected from both groups of patients. An untargeted metabolic method was used to identify differences in serum metabolomic profiles between the EA patients and the non-EA patients. Results A total of 19 EA patients and 32 matched non-EA patients were included in the study. After screening and mapping with a database, 12 metabolites showed significant postoperative alterations in EA patients compared with non-EA patients, and were mainly involved in lipid, fatty acid and amino acid metabolism pathways. Receiver operating characteristic curve analyses indicated that vanillic acid, candoxatril, tiglylglycine, 5-methoxysalicylic acid, decanoylcarnitine, and 24-epibrassinolide may be involved in EA pathogenesis after general anesthesia. Conclusion In this study, we found differences in the serum levels of vanillic acid, candoxatril, tiglylglycine, 5-methoxysalicylic acid, decanoylcarnitine, and 24-epibrassinolide involved in fatty acid metabolism, lipid metabolism, and amino acid metabolism pathways in EA patients compared with non-EA patients, which may demonstrate an EA pathogenesis-associated molecular pattern and contribute toward better understanding of EA occurrence.
Collapse
Affiliation(s)
- Xinning Mi
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jingshu Hong
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Zhengqian Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Taotao Liu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Qian Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jiansuo Zhou
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Yitong Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xiaoxiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yi Yuan
- Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ning Yang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yongzheng Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yang Zhou
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yue Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- *Correspondence: Yue Li,
| | - Dengyang Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
- Dengyang Han,
| |
Collapse
|