Objectives: 

To describe the relationships between anticholinergic drug exposure, cholinesterase enzyme activity, inflammation, and the development of postoperative delirium in children.

Design: 

Single-center prospective cohort study.

Setting: 

Twenty-two bed PICU in a tertiary-care academic medical center in Germany.

Patients: 

A consecutive cohort of children admitted after major elective surgery.

Interventions: 

Children were screened for delirium bid over 5 consecutive postoperative days. Acetylcholinesterase and butyrylcholinesterase plasma activity levels were measured prior to surgery and once daily during the 5 day study period. Number of anticholinergic drugs and Anticholinergic Drug Scale score were calculated for each patient.

Measurements and Main Results: 

Ninety-three children (age range, 0–17 yr) were included. The number of anticholinergic drugs as well as the Anticholinergic Drug Scale score were significantly correlated with development of postoperative delirium, independently of disease severity. Baseline cholinesterase enzyme levels did not differ between patients who did and did not develop postoperative delirium. Butyrylcholinesterase levels, but not acetylcholinesterase levels, dropped by 33% postoperatively, independent of the presence of postoperative delirium. Postoperative butyrylcholinesterase levels were inversely related to number of anticholinergic drugs, Anticholinergic Drug Scale score, and C-reactive protein levels.

Conclusions: 

Anticholinergic drug exposure was related to development of postoperative delirium in this cohort, with demonstration of a dose-response relationship. As there are alternative options available for many of these medications, it may be reasonable to avoid anticholinergic exposure in the PICU whenever possible.

中文翻译：

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儿科Deli妄术后胆碱酯酶和抗胆碱能药物。

目标： 

描述儿童抗胆碱能药物暴露，胆碱酯酶活性，炎症和术后del妄发展之间的关系。

设计： 

单中心前瞻性队列研究。

设置： 

在德国三级学术医疗中心的22张床重症监护病房（PICU）。

耐心： 

大选手术后连续入组的儿童。

干预措施： 

连续5天对儿童进行del妄检查。在手术前和为期5天的研究期间每天测量一次乙酰胆碱酯酶和丁酰胆碱酯酶的血浆活性水平。计算每位患者的抗胆碱能药物数量和抗胆碱能药物量表评分。

测量和主要结果： 

包括九十三名儿童（年龄段，0-17岁）。抗胆碱能药物的数量以及抗胆碱能药物量表的评分与术后del妄的发生密切相关，而与疾病的严重程度无关。基线胆碱酯酶水平在没有发生develop妄的患者之间没有差异。术后丁酰胆碱酯酶水平而非乙酰胆碱酯酶水平下降了33％，与术后del妄的存在无关。术后，丁酰胆碱酯酶水平呈负相关的数量抗胆碱能药物，抗胆碱 药物量表评分和C反应蛋白水平。

结论： 

在该队列研究中，抗胆碱能药物暴露与术后del妄的发生有关，并显示出剂量-反应关系。由于许多此类药物都有其他选择，因此尽可能避免在PICU中接受抗胆碱能暴露可能是合理的。