一般麻酔後の患者の経験に対する鎮静剤前療法の効果:ランダム化臨床試験

Axel Maurice-Szamburski¹, Pascal Auquier², Véronique Viarre-Oreal¹

¹Service d'Anesthésie Réanimation, Hôpital de la Timone Adulte, Marseille, France.

JAMA

|March 4, 2015

まとめ

ロラゼパムによる鎮静前治療は,手術後の患者の満足度を改善しませんでした. これは,エクスチューベーションの時間が長くなり,早期の認知回復が低下するとの関連があり,その日常的な使用が疑問視された.

科学分野:

アネステシオロジーアネステシオロジー
周術医療 (Perioperative Medicine) とは,外科手術の際の治療法である.
患者体験は患者さんの体験です.

背景:

鎮静剤のプレメディケーションは,手術前の一般的な慣行ですが,その有効性を支持する堅実な臨床的証拠は限られています.
PremedX研究では,通常の鎮静剤のプレメディケーションが患者のアウトカムに与える影響を調査した.

研究の目的:

ロラゼパムによる鎮静前治療の効果を,手術後の患者の経験に評価する.
排尿までの時間および早期の認知回復を含む二次的アウトカムを評価する.

主な方法:

ランダム化臨床試験 (PremedX研究) で,全身麻酔で選択手術を受けた1062人の成人患者が対象となった.
患者はランダムにロラゼパム,プレメディケーションなし,またはプラセボを受けるように割り当てられました.
外科手術後の患者の経験は,手術後24時間以内に検証されたEVAN-Gアンケートを使用して測定されました.

主要な成果:

ローラゼパムのプレメディケーションは,プラセボまたはプレメディケーションなしと比較して,患者全体の満足度スコアを有意に改善しませんでした.
高度な手術前不安を持つ患者のサブグループ分析も,満足度の有意な違いを示さなかった.
ローラゼパムを投与された患者は,エクストゥベーションまでの時間が長く,他のグループと比較して早期の認知回復率が低かった.

結論:

ロラゼパムによる定期的な鎮静薬前治療は,選択手術後の患者体験を向上させません.
ローラゼパムの使用は,外科手術後のエクスチューベーションの遅延と認知機能の低下と関連していました.
これらの発見は,ロラゼパムの定期的な投与が,全身麻酔におけるプレメディケーションとして有益ではないことを示唆しています.

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