Abstract
Background: Volatile anesthetic-induced agitation, also called paradoxical excitation, is not uncommon during anesthesia induction. Clinically, patients with agitation may lead to self-injury or disrupt the operative position, increasing the incidence of perioperative adverse events. The study was designed to investigate clinical features of sevoflurane-induced agitation and examined whether any gene polymorphisms can potentially be used to predict agitation.Methods: One hundred seventy-six patients underwent anesthesia induction with sevoflurane were included in this study. Frontal electroencephalogram (EEG), electromyography (EMG), and hemodynamics were recorded continuously during anesthesia induction. DNA samples were genotyped using the Illumina Infinium Asian Screening Array and the SNaPshot technology. Genetic association was analyzed by genome-wide association study. Logistic regression analysis was used to determine the role of variables in the prediction of agitation.Results: Twenty-five (14.2%) patients experienced agitation. The depth of anesthesia index (Ai index) (p < 0.001), EMG (p < 0.001), heart rate (HR) (p < 0.001), and mean arterial pressure (MAP) (p < 0.001) rapidly increased during the agitation. EEG exhibited a shift toward high frequencies with spikes during agitation. The fast waves (alpha and beta) were more pronounced and the slow rhythms (delta) were less prominent during the occurrence of agitation. Moreover, three SNPs in the methionine synthase reductase (MTRR) gene were correlated to the susceptibility to agitation (p < 5.0 × 10−6). Carrying rs1801394 A > G (odds ratio 3.50, 95% CI 1.43–9.45) and/or rs2307116 G > A (3.31, 1.36–8.95) predicted a higher risk of agitation.Discussion: This study suggests that the agitation/paradoxical excitation induced by sevoflurane is characterized as increases in Ai index, EMG, HR and MAP, and the high frequency with spikes in EEG. Moreover, our results provide preliminary evidence for MTRR genetic polymorphisms, involving folate metabolism function, may be related to the susceptibility to agitation.Clinical Trial Number and Registry URL: ChiCTR1900026218; http://www.chictr.org.cn/showproj.aspx?proj=40655.
Highlights
Volatile anesthetics have been widely used for the induction and maintenance of anesthesia in clinics for more than 170 years, but the mechanism of their effects remains elusive [1]
This study suggests that the agitation/paradoxical excitation induced by sevoflurane is characterized as increases in Ai index, EMG, heart rate (HR) and mean arterial pressure (MAP), and the high frequency with spikes in EEG
We discovered that (i) anesthesia induction with sevoflurane could induce agitation and its incidence was 14.2% (25/176); (ii) Patients with agitation were characterized as increases in Ai index, EMG, HR, and MAP; (iii) EEG displayed a shift toward high frequencies with spikes during agitation
Summary
Volatile anesthetics have been widely used for the induction and maintenance of anesthesia in clinics for more than 170 years, but the mechanism of their effects remains elusive [1]. Called paradoxical excitation, is not uncommon during anesthesia induction with an incidence reported to range from 5 to 60% [5,6,7]. Previous studies have been reported that induction agitation, emergence agitation, and postoperative delirium have similar characteristics with disturbance of consciousness and excited behavior [5, 9,10,11]. This implies that the same or similar mechanism may underlie. Volatile anesthetic-induced agitation, called paradoxical excitation, is not uncommon during anesthesia induction. The study was designed to investigate clinical features of sevoflurane-induced agitation and examined whether any gene polymorphisms can potentially be used to predict agitation
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