Inadequate emergence after anesthesia for elective cancer surgery: a single-center cohort study
Despertar inadequado após anestesia para cirurgia eletiva de câncer: um estudo de coorte de centro único
Inadequate emergence after anesthesia (IEA) is a common phenomenon in adult patients undergoing anesthesia. The aim of this study was to evaluate the incidence and determinants of IEA for elective cancer surgery, and to study its influence on the quality of recovery.
In this observational, prospective study, 148 patients scheduled for elective cancer surgery were included. IEA was considered for patients having emergence delirium or hypoactive emergence applying The Richmond Agitation and Sedation Scale (RASS) 10 minutes after admission at PACU. Postoperative Quality of Recovery Scale (PQRS) was used at baseline and after surgery at minutes 15 (T15) and 40 (T40), and days 1 (D1) and 3 (D3).
Of the 148 patients, 48 (32%) had IEA. Complete recovery at PQRS was less frequent in patients with IEA on physiological domain at T15 and D1, and activities of daily living domain at D3. Patients with IEA recovered more frequently in emotive domain at T15, T40, and D3. Determinants of IEA were age, risk of surgery, congestive heart disease, cerebrovascular disease, ASA physical status, RCRI score, and duration of anesthesia. IEA patients had more frequently postoperative delirium and stayed for longer at PACU and at the hospital.
IEA was a common phenomenon after anesthesia for elective curative surgery for cancer. Patients with IEA were older and had more comorbidities and a higher surgical risk. Patients with IEA had a less frequent complete recovery on the PD and in AD domains, and a more frequent complete recovery on the ED.
Justificativa: O despertar inadequado após a anestesia (DIAA) é um fenômeno comum em pacientes adultos submetidos à anestesia. O objetivo deste estudo foi avaliar a incidência e os determinantes do DIAA para cirurgia oncológica eletiva e estudar sua influência na qualidade da recuperação. Métodos: Neste estudo observacional e prospectivo, 148 pacientes agendados para cirurgia eletiva de câncer foram incluídos. O DIAA foi considerado para pacientes com delírio ao despertar ou despertar hipoativo, aplicando-se a Escala de Agitação e Sedação de Richmond (RASS) 10 minutos após a admissão na SRPA. A Escala de Qualidade de Recuperação Pós-Operatória (PQRS) foi usada no início e após a cirurgia nos minutos 15 (T15) e 40 (T40) e nos dias 1 (D1) e 3 (D3). Resultados: Dos 148 pacientes, 48 (32%) apresentaram DIAA. A recuperação completa no PQRS foi menos frequente nos pacientes com DIAA no domínio fisiológico em T15 e D1 e no domínio atividades de vida diária em D3. Pacientes com DIAA se recuperaram mais frequentemente no domínio emotivo em T15, T40 e D3. Determinantes de DIAA foram idade, risco de cirurgia, doença cardíaca congestiva, doença cerebrovascular, estado físico ASA, pontuação RCRI e duração da anestesia. Os pacientes com DIAA apresentaram delirium pós-operatório com maior frequência e permaneceram mais tempo na SRPA e no hospital. Conclusão: DIAA foi um fenômeno comum após anestesia para cirurgia curativa eletiva para câncer. Os pacientes com DIAA eram mais velhos e apresentavam mais comorbidades e maior risco cirúrgico. Os pacientes com DIAA tiveram uma recuperação completa menos frequente nos domínios DP e AD e uma recuperação completa mais frequente no ED.
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