Предикторы развития двигательных нарушений при пробуждении после общей анестезии у пациентов травматологического профиля (проспективное когортное исследование)

Abstract

Analysis of published studies shows that information on patients' hyperactivity on awakening is ambiguous, both regarding the definition of this condition itself and the causes of its occurrence. In the field of neurology and neurophysiology, there is a lack of data on the mechanisms of development of early cognitive impairment after surgery, as well as on the definition of vulnerable patients before surgery and anesthesia. Objective. To determine the prognostic value of predictors of different values on the RASS scale in trauma patients to assess the development of major clinical outcomes. Material and methods. A two-center prospective cohort study of patients aged 45–74 years after planned traumatologic surgeries under general anesthesia was conducted. Demographics, comorbidities, background therapy, preoperative laboratory examinations and testing (ASA, MoCA, AUDIT, CFS, HADS-A, RASS) were analyzed as part of the study. After extubation in the operating room, patients were evaluated using the RASS, CAM-ICU, CAM-ICU-7, NRS, and BPS scales. Statistical analysis was performed using SPSS Statistics 27.0.1.0 software. Results. Two hundred subjects were included in the study between March 2021 and June 2022. An independent predictor of positive Richmond Agitation-Sedation Scale (RASS) values after extubation in the operating room was adherence to alcohol (AUDIT test, optimal cut-off point ≥2 points, Se=59.2%, Sp=72.2%, estimate=0.440; 95% confidence interval (CI) 0.158-0.723, p=0.002). Risk factors of zero and negative RASS scores were found to be predictors of satisfactory quality by ROC analysis. When assessing the impact on clinical outcomes, differences were observed between the groups of patients with positive and zero values on the RASS scale. Conclusion. Patients with positive values on the RASS scale were statistically significantly more likely to have postoperative delirium - 12 (24.5%) patients, p=0.002.