Abstract
Flumazenil, a gamma-aminobutyric acid receptor antagonist, can promote arousal even under general anesthesia without the use of benzodiazepines. We hypothesized that flumazenil could promote arousal and reduce emergence agitation in patients undergoing orthognathic surgery with sevoflurane anesthesia. One hundred and two patients were randomly allocated to the control or flumazenil group. Saline or flumazenil was administered at the end of the surgery. The incidence of emergence agitation was measured by using Aono’s four-point scale, with scores of 3 and 4 indicating emergence agitation. The primary outcome was the incidence of emergence agitation. Secondary outcomes included duration of emergence agitation and time intervals between the discontinuation of anesthetics, first response, extubation, and post-anesthesia care-unit discharge readiness. The incidence of emergence agitation was 58.3% and 38.9% in the control and flumazenil groups, respectively, but it was not statistically significant. However, the duration of emergence agitation was shorter in the flumazenil group (p = 0.012). There were no significant differences in the time intervals between the discontinuation of anesthetics, first response, and extubation. Although flumazenil did not reduce the incidence of emergence agitation in patients undergoing orthognathic surgery with sevoflurane anesthesia, it can be considered as an option for awakening patients in terms of improving emergence profiles.
Highlights
Emergence agitation is characterized by confusion, restlessness, and hyperactive physical behavior resulting from a temporary loss of consciousness during recovery from general anesthesia
In a previous study, when desflurane was used during orthognathic surgery, rapid awakening resulted in early situational awareness; emergence agitation was reduced compared to sevoflurane [5]
The purpose of this study was to investigate whether flumazenil can reduce emergence agitation in adult patients undergoing orthognathic surgery under general anesthesia, using sevoflurane
Summary
Emergence agitation is characterized by confusion, restlessness, and hyperactive physical behavior resulting from a temporary loss of consciousness during recovery from general anesthesia. It has an incidence of 0.25% to 90.5% and is considered a very important dilemma in postoperative care because it increases the risk of self-extubation, unintended removal of catheters, surgical site injury, and postoperative bleeding [1,2]. In a previous study, when desflurane was used during orthognathic surgery, rapid awakening resulted in early situational awareness; emergence agitation was reduced compared to sevoflurane [5]. Desflurane tends to increase the patient’s heart rate during anesthesia, and epinephrine injection during orthognathic surgery, administered to reduce the bleeding, can cause tachycardia [6]. We attempted to determine a way to reduce emergence agitation while using sevoflurane
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