| Objective: Emergence delirium(ED)after general anaesthesia(GA)is a well-known phenomenon,yet the pathogenesis is still unclear.Current evidence have showed that melatonin deficiency appears to play a role in thepathogenesis of delirium.Melatonin is a neuroendocrine hormone synthesized and secreted mainly by the pineal gland,and it is a major chronobiological regulator involved in circadian phasing and sleep-wake cycle in humans.The purpose of this study is to observe the effects of different anesthesia methods on melatonin concentration and emergence delirium of elderly patients with knee replacement,and to investigate the relationship between perioperative melatonin concentration and emergence delirium.Methods: This prospective randomized controlled study was approved by hospital ethical committee.60 cases of patients over 65 years old who received elective knee replacement surgery during the period July 2016 to October 2016 were eligible for the study.After written informed consent was obtained,subjiects were randomly divided into two study groups.The NG group received general anesthesia combined with femoral nerve block while the G group received single general anesthesia.Before the patient was admitted to the operation room for anesthesia(T1),3ml venous blood samples were collected.The G group underwent conventional general anesthesia induction,whereas the NG group received femoral nerve block guided by the B Ultrasound combined with nerve stimulator,the range of nerve block being measured in 5 minutes,and then underwent the induction of general anesthesia.During the operation,the two groups of patients were treated with the uniform anesthesia maintenance program.At the end of the operation,all anesthetic drugs were stopped(T2),the amount of general anesthetics used during the operation,the amount of bleeding,the amount of urine,the amount of fluid infusion,the time of anesthesia,the time of operation were recorded,and 3ml venous blood samples were collected at the same time.All patients were sent to postanesthesia care unit(PACU)after the operation.When patients opened eyes and accorded with extubation indication,removed the laryngeal mask.In the meantime,a professional nurse evaluated the emergency delirium score and pain score according to the Nursing Delirium Screening Scale(Nu-DESC)and the visual analogue scale(VAS)respectively.After laryngeal mask was removed,all patients were evaluated every 5 minutes for delirium and pain score until the patient left PACU.Both delirium score and pain score were the highest value in our study.The recovery time,recovery room residence time,nausea and vomiting were also recorded.The patients were evaluated and the data were recorded by the same professional nurse during PACU.An anesthesiologist was responsible for measuring melatonin concentrations and collecting data on postoperative delirium,pain,initial walking time,walking distance of the third day after surgery and information related to adverse reactions,the duration of hospitalization and discharge mode(normal discharge from the hospital,signature or death).Results: Finally,50 patients were included in our study.Both G group and NG group were 25 cases.1.There was no significant difference between the two groups in sex ratio,age,body mass index(BMI),ASA classification and preoperative cognitive function score(P > 0.05).2.There was no significant difference between the two groups in intraoperative blood loss,intraoperative urine volume,intraoperative fluid volume,anesthesia time and operation time(P > 0.05).The amount of intravenous anesthesia drugs(propofol,remifentanil,sufentanil)of NG group was less than that of G group and the difference has statistical significance(P < 0.05).3.Compared with the G group,the NG group recovered more quickly,the recovery room residence time was shorter and the pain score was lower,the difference was statistically significant(P < 0.05).The incidence of nausea and vomiting during the recovery period was not statistically significant between NG and G group(P > 0.05).The incidence of emergence delirium had no statistical difference between the two groups(4% vs 20%,p>0.05),but compared with G group,the emergence delirium score of NG group is lower than that of G group,and the difference was statistically significant(2.64 ± 1.25 vs 1.04 ± 0.93,p<0.05).4.There was no significant difference between the two groups in the incidence of postoperative delirium,pain scores,walking distance of the third day after surgery,mortality and adverse reactions(nausea,vomiting,itching,urinary retention)(P > 0.05).Compared with G group,lower pain score,earlier initial walking time and shorter hospitalization time were found in the NG group,and the difference was statistically significant(P < 0.05).5.The preoperative melatonin concentration had no significant difference between the two groups(52.15 ± 12.13 vs 54.10 ±11.43,P > 0.05),but the postoperative melatonin concentration of NG group is higher than that of G group,and the difference was statistically significant(51.50 ±18.46 vs 42.29 ± 12.95,p<0.05).In the NG group,there was no significant difference between postoperative melatonin concentration and preoperative melatonin concentration(51.50 ± 18.46 vs 52.15 ±12.13,P > 0.05),whereas in the G group,the postoperative melatonin concentration was remarkably lower than preoperative melatonin concentration,and the difference was statistically significant(42.29 ±12.95 vs 54.10 ± 11.43,p<0.05).The ?melatonin concentration of NG group was lower than that of G group,and the difference was statistically significant(0.65 ± 13.67 vs 11.81± 6.32, p<0.05).6.Spearman correlation analysis showed that the emergence delirium score and postoperative melatonin concentration was negatively correlated,the correlation coefficient r=-0.429,p<0.05;emergence delirium score and ?melatonin concentration were positively correlated,correlation coefficient r=0.741,p<0.05.Conclisions: For elderly patients undergoing knee replacement surgery,emergence delirium score is negatively correlated with postoperative melatonin concentration while positively correlated with the descent range of perioperative melatonin concentration.With less impcat on postoperative melatonin concentration and significant reduction of emergence delirium score,general anesthesia combined with femoral nerve block is more conducive to the recovery of patients after surgery compared with single general anesthesia. |
PDF Full Text Request