选择性手术后老年人中的麻醉剂和术后妄想:塞沃弗兰和普罗波福尔之间的回顾性比较
Yasser Ahmed Abdelaziz El Kerdasy1, Ibrahim Fadl Mahmoud2, Neazy Abdmokhles Abdelmottaleb2
1Department of Hepatogastroenterology, Al-Azhar Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Medical journal of the Islamic Republic of Iran
|June 9, 2025
概括
在老年患者中,与sevoflurane相比,使用propofol麻醉时,术后狂妄症 (POD) 的发生率更高. POD危险因素包括麻醉剂,ASA身体状况和糖尿病.
科学领域:
- 麻醉学 麻醉学
- 老年医学 老年医学
- 关键护理医学 关键护理医学
背景情况:
- 手术后痴呆症 (POD) 是老年患者的一个重大问题,与增加的发病率和死亡率有关.
- 麻醉剂与POD的发展有关,但之前的研究结果不一致.
- 本研究研究了sevoflurane和propofol全身麻醉后的POD发生率和相关因素.
研究的目的:
- 为了确定老年人手术后 Delirium (POD) 的发生率.
- 为了确定与POD在sevoflurane或propofol全身麻醉后发展相关的因素.
- 为了比较sevoflurane和propofol麻醉之间的POD率.
主要方法:
- 对200名老年患者进行了回顾性研究,这些患者在全身麻醉下接受了选择性手术.
- 从医疗记录中收集的数据,包括患者的特征,麻醉剂 (sevoflurane或propofol) 和术后结果.
- 统计分析包括独立样本的t-test,Chi-Square和几率比率计算来评估关联.
主要成果:
- 在普罗波福尔麻醉后,POD的发生率明显高 (30.0%),相比之下,sevoflurane (14.0%).
- POD与较高的ASA身体状况 (ASA-III),糖尿病以及使用的麻醉剂类型有显著的关联.
- 治疗时间较短的sevoflurane (249.91±45.41分钟) 与propofol (264.60±45.78分钟),但其他手术前和手术后的数据显示没有显著差异.
结论:
- 与sevoflurane相比,propofol全身麻醉与老年患者中术后妄想的发生率更高有关.
- 导致POD的关键因素包括麻醉剂,较高的ASA身体状况和糖尿病的存在.
- 研究结果表明,在患有妄想风险的老年患者中,应仔细考虑麻醉选择.
相关概念视频
Parenteral Anesthetics: Overview
107
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.
107
Inhalational Anesthetics: Overview
228
Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
228
General Anesthesia: Overview
196
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...
196
Stages of General Anesthesia
383
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...
383
Local Anesthetics: Clinical Application as Epidural Anesthesia
421
Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
421
Local Anesthetics: Clinical Application as Spinal Anesthesia
591
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
591


