小儿术后谵妄与躁动到底怎么办呢？( 二 ) _健康小知识

治疗
除了支持和预防伤害外，许多ED儿童不需要治疗。约95%的ED儿童在发病后20分钟内自行消失，无持续后遗症。
对于在恢复室出现躁动的儿童，应首先评估有无疼痛和潜在危险的躁动原因(即缺氧、低血压、高碳酸血症和低血糖) ，如果疼痛是诱因，适当采用镇痛药。
如果需要治疗，可使用镇静剂和阿片类药物。尚无对比这种情况下各种治疗的研究。一项针对加拿大麻醉科医师的调查显示，最常用于终止儿童ED的干预措施是丙泊酚(42%)、咪达唑仑(31%)、芬太尼(10%)、吗啡(7%)和右美托咪定(5%)[18] 。一旦ED发作缓解，无论是自发消退还是通过干预， ED复发都未见报道。

文章图片
（照片拍摄者：黄蕾蕾医生）
作者：张子银广州中医药大学第一附属医院
参考文献
1.MalarbiS,StargattR,HowardK,DavidsonA.Characterizingthebehaviorofchildrenemergingwithdeliriumfromgeneralanesthesia.PaediatrAnaesth2011;21:942.
2.SikichN,LermanJ.Developmentandpsychometricevaluationofthepediatricanesthesiaemergencedeliriumscale.Anesthesiology2004;100:1138.
3.AonoJ,UedaW,MamiyaK,etal.Greaterincidenceofdeliriumduringrecoveryfromsevofluraneanesthesiainpreschoolboys.Anesthesiology1997;87:1298.
4.UezonoS,GotoT,TeruiK,etal.Emergenceagitationaftersevofluraneversuspropofolinpediatricpatients.AnesthAnalg2000;91:563.
5.BeskowA,WestrinP.Sevofluranecausesmorepostoperativeagitationinchildrenthandoeshalothane.ActaAnaesthesiolScand1999;43:536.
6.KanayaA,KurataniN,SatohD,KurosawaS.Lowerincidenceofemergenceagitationinchildrenafterpropofolanesthesiacomparedwithsevoflurane:ameta-analysisofrandomizedcontrolledtrials.JAnesth2014;28:4.
7.CostiD,CynaAM,AhmedS,etal.Effectsofsevofluraneversusothergeneralanaesthesiaonemergenceagitationinchildren.CochraneDatabaseSystRev2014;:CD007084.
8.FaulkDJ,TwiteMD,ZukJ,etal.Hypnoticdepthandtheincidenceofemergenceagitationandnegativepostoperativebehavioralchanges.PaediatrAnaesth2010;20:72.
9.KainZN,Caldwell-AndrewsAA,MaranetsI,etal.Preoperativeanxietyandemergencedeliriumandpostoperativemaladaptivebehaviors.AnesthAnalg2004;99:1648.
10.BreschanC,PlatzerM,JostR,etal.Midazolamdoesnotreduceemergencedeliriumaftersevofluraneanesthesiainchildren.PaediatrAnaesth2007;17:347.
11.KimN,ParkJH,LeeJS,etal.Effectsofintravenousfentanylaroundtheendofsurgeryonemergenceagitationinchildren:Systematicreviewandmeta-analysis.PaediatrAnaesth2017;27:885.
12.MakkarJK,BhatiaN,BalaI,etal.Acomparisonofsingledosedexmedetomidinewithpropofolforthepreventionofemergencedeliriumafterdesfluraneanaesthesiainchildren.Anaesthesia2016;71:50.
13.ZhuM,WangH,ZhuA,etal.Meta-analysisofdexmedetomidineonemergenceagitationandrecoveryprofilesinchildrenaftersevofluraneanesthesia:differentadministrationanddifferentdosage.PLoSOne2015;10:e0123728.
14.ZhangC,LiJ,ZhaoD,WangY.Prophylacticmidazolamandclonidineforemergencefromagitationinchildrenafteremergencefromsevofluraneanesthesia:ameta-analysis.ClinTher2013;35:1622.
15.ShiM,MiaoS,GuT,etal.Dexmedetomidineforthepreventionofemergencedeliriumandpostoperativebehavioralchangesinpediatricpatientswithsevofluraneanesthesia:adouble-blind,randomizedtrial.DrugDesDevelTher2019;13:897.
16.ChenJY,JiaJE,LiuTJ,etal.Comparisonoftheeffectsofdexmedetomidine,ketamine,andplaceboonemergenceagitationafterstrabismussurgeryinchildren.CanJAnaesth2013;60:385.
17.DalensBJ,PinardAM,LétourneauDR,etal.Preventionofemergenceagitationaftersevofluraneanesthesiaforpediatriccerebralmagneticresonanceimagingbysmalldosesofketamineornalbuphineadministeredjustbeforediscontinuinganesthesia.AnesthAnalg2006;102:1056.
18.RosenHD,MervitzD,CraveroJP.Pediatricemergencedelirium:CanadianPediatricAnesthesiologists'experience.PaediatrAnaesth2016;26:207.
【小儿术后谵妄与躁动到底怎么办呢？】【温馨提示】点个关注，这里有大量专业的医学科普，为您揭秘手术麻醉的那些事儿~