支持-反对辩论:用于减少术后妄想的电脑学引导麻醉
David Hao1, Bradley A Fritz2, Daniel Saddawi-Konefka1
1From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Anesthesia and analgesia
|October 20, 2023
概括
脑电图 (EEG) 监测可能有助于减少手术后妄 (POD). 然而,关于EEG的证据是有争议的.
科学领域:
- 麻醉学 麻醉学
- 神经科学是一个神经科学.
- 老年医学 老年医学
背景情况:
- 手术后痴呆症 (POD) 显著增加了患者的发病率,死亡率和医疗费用.
- 在麻醉期间监测脑电图 (EEG) 正在探索作为一种减少POD的方法.
- 关于EEG在缓解POD中的实用性的辩论是非常重要的,因为 Delirium 的公共卫生负担越来越大.
研究的目的:
- 关于使用EEG监测来缓解手术后妄想症的支持者辩论.
- 批判性地评估支持和反驳EEG导向麻醉用于POD预防的证据.
主要方法:
- 本评论回顾了关于经过处理的EEG (pEEG) 引导全身麻醉的现有研究和元分析.
- 它讨论了对麻醉以缓解老年综合征 (ENGAGES) 试验的脑电学指导.
- 提出了支持和反对EEG使用的论点,考虑因果关系,最佳EEG签名和麻醉深度风险.
主要成果:
- 支持者引用的研究和元分析显示,使用pEEG导向麻醉降低了POD的发生率.
- 值得注意的是,ENGAGES试验作为一个例外,提出了方法方面的担忧.
- 反对者质疑麻醉深度和POD之间的因果关系,以及缺乏定义的EEG目标.
结论:
- 关于EEG显著减少POD的证据仍在争论中.
- 有关EEG数据的解释以及麻醉深度和潜在风险之间的平衡存在担忧.
- 麻醉临床医生必须权衡使用EEG预防POD的潜在好处与不确定性.
相关概念视频
General Anesthesia: Overview
225
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
225
Parenteral Anesthetics: Overview
136
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
136
Stages of General Anesthesia
473
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
473
Electroconvulsive Therapy
47
Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
47


