Prospective Cohort Study For Independent Risk Factor Of Delayed Recovery In General Anesthesia Patients

Objective:Postoperative delayed recovery is an important complication of general anesthesia. It can increase perioperative risk in patients with general anesthesia, slow down patients’ recovery from the operation, increase the financial burden of patients, and even cause death. Therefore, to explore the risk factors of delayed recovery after anesthesia is of importance. However, the factors leading to delayed recovery is very complicated. This paper aims to study risk factors of delayed postoperative recovery, explore the independent risk factors and provide more guidance and basis for clinical anesthesia work.Materials and Methods:Collect 458 adult patients’information from February 2015 to February 2016 in PACU in Shandong Provincial Hospital, who took non-cardiac surgery under general anesthesia. Collected demographic information:gender, age, height, weight, BMI, hypertension or not, diabetes or not, coronary heart disease or not, smoking or not, drinking habits, ASA grade Ⅱ or Ⅲ, NYHA cardiac functional class Ⅰ,Ⅱ or Ⅲ, Hb level, blood glucose level, level of electrolytes Na+, K+, Ca2+. Detect electrocardiogram (ECG), heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO2), and nasopharyngeal temperature (T) after coming into operation room. The way of anesthesia is general anesthesia. About 15 minutes before the end of the surgery, stop giving propofol, and 30 minutes before the end of the surgery, stop giving cis atracurium. When the patients begin to swallow or breathe, we give neostigmine 1mg and atropine 0.3mg. After surgery the patients are sent to PACU.Perioperative data acquisition:Type of surgery:abdominal surgery, thoracic surgery, spinal or limb surgery,superficial or transurethral surgery, laparoscopic surgery or not, inhaling sevoflurane or not, the length of surgery time, time of anesthesia length, cancer or not, amount of blood loss, amount of intraoperative transfusion intraoperative blood transfusion or not, postoperative temperature, recovery time, using antihypertensive drugs or not, using vasopressors or not, medetomidine application or not. Steward score can help determine whether the patient awake and then us Logistic regression analysis to identify patients with risk factors for delayed awakening.Results:296 cases were analyzed according to the criteria, of which 26 patients developed post-anesthesia delay. After univariate analysis, clinical analysis and multicol linearity test, the age, diabetes, smoking, abnormal potassium, sevoflurane, intraoperative blood transfusion, intraoperative transfusion, postoperative recovery room awake into the body, use of antihypertensive drugs, the use of vasopressors come into Logistic regression analysis.Finally we find the conclusion that the independent risk factors of delayed recovery are age (OR 0.924,95% CI 0.877-0.972, P= 0.002), intraoperative fluid volume (OR 0.953,95% CI 0.919-0.989, P= 0.01), intraoperative blood transfusion (OR 5.647,95% CI 1.160-27.501, P= 0.032) and postoperative temperature (OR 372.276,95% CI 21.756-6370.150, P <0.001). From patients’age and intraoperative transfusion volume according to ROC curve analysis we obtain that age over 60 years old and intraoperative fluid volume over 51.7ml/kg can increase the risk of delayed recovery. Then we make age and volume of transfusion into Logistic regression analysis model again, and get the result that older than 60 years (OR 0.174,95% CI 0.051-0.588, P= 0.005), transfusion volume of more than 51.7ml/kg (OR 0.216,95% CI 0.070-0.670, P= 0.008) increase the risk of delayed recovery obviously.Conclusions:For patients taking non-cardiac surgery under general anesthesia, increasing age (age> 60 years), excess transfusion (fluid volume> 51.7ml/kg) are independent risk factor for postoperative delayed recovery.