Incidence Of Emergence Agitation Research Articles

Adult Emergence Agitation: A Veteran-Focused Narrative Review.

Emergence agitation (EA) is a self-limited state of psychomotor excitement during awakening from general anesthesia. EA is confined to the emergence period as consciousness is restored, which sharply distinguishes it from other postoperative delirium states. Sporadic episodes of EA may become violent with the potential for harm to both patients and caregivers, but the long-term consequences of such events are not fully understood. Current literature on EA in adults is limited to small-scale studies with inconsistent nomenclature, variable time periods that define emergence, a host of different surgical populations, and conflicting diagnostic criteria. Therefore, true incidence rates and risk factors are unknown. In adult noncardiac surgery, the incidence of EA is approximately 19%. Limited data suggest that young adults undergoing otolaryngology operations with volatile anesthetic maintenance may be at the highest risk for EA. Currently suggested EA mechanisms are theoretical but might reflect underblunted sympathetic activation in response to various internal (eg, flashbacks or anxiety) or external (eg, surgical pain) stimuli as consciousness returns. Supplemental dexmedetomidine and ketamine may be utilized for EA prevention. Compared to the civilian population, military veterans may be more vulnerable to EA due to high rates of posttraumatic stress disorder (PTSD) manifesting as violent flashbacks; however, confirmatory data are limited. Nonetheless, expert military medical providers suggest that use of patient-centered rapport tactics, PTSD trigger identification and avoidance, and grounding measures may alleviate hyperactive emergence phenomena. Future research is needed to better characterize EA in veterans and validate prophylactic measures to optimize care for these patients. This narrative review provides readers with an important framework to distinguish EA from delirium. Furthermore, we summarize current knowledge of EA risk factors, mechanisms, and adult management strategies and specifically revisit them in the context of veteran perioperative health. The anesthesiology care team is ideally positioned to further explore EA and develop effective prevention and treatment protocols.

Dexmedetomidine for prevention of postoperative delirium in older adults undergoing oesophagectomy with total intravenous anaesthesia: A double-blind, randomised clinical trial.

Dexmedetomidine is known to be a sedative. Recent studies suggest that administration of dexmedetomidine can prevent postoperative delirium (POD) which has been confirmed as a common complication after major surgery. However, its effects in patients undergoing oesophagectomy are scarce. To investigate the efficacy and safety of dexmedetomidine in reducing POD in elderly patients after transthoracic oesophagectomy with total intravenous anaesthesia (TIVA). A randomised, double-blind, placebo-controlled trial. Single-centre, tertiary care hospital, November 2016 to September 2018. Eligible patients (n = 177) undergoing transthoracic oesophagectomy were randomly assigned to receive total intravenous anaesthesia (TIVA, n = 87) or dexmedetomidine with TIVA (DEX-TIVA, n = 90). Patients receiving DEX-TIVA received a loading dose of dexmedetomidine (0.4 μg kg-1), over 15 min, followed by a continuous infusion at a rate of 0.1 μg kg-1 h-1 until 1 h before the end of surgery. Patients receiving TIVA received physiological saline with a similar infusion rate protocol. The primary outcome was the incidence of POD. The secondary endpoints were the incidence of emergence agitation, serum interleukin-6 (IL-6) levels and haemodynamic profile. All randomised patients were included with planned intention-to-treat analyses for POD. Delirium occurred in 15 (16.7%) of 90 cases given dexmedetomidine, and in 32 (36.8%) of 87 cases given saline (P = 0.0036). The DEX-TIVA group showed less frequent emergence agitation than the TIVA group (22.1 vs. 48.0%, P = 0.0058). The incremental change in surgery-induced IL-6 levels was greater in the TIVA group than DEX-TIVA group (P < 0.0001). Adding peri-operative dexmedetomidine to a total intravenous anaesthetic safely reduces POD and emergence agitation in elderly patients undergoing open transthoracic oesophagectomy. These benefits were associated with a postoperative reduction in circulating levels of the pro-inflammatory cytokine IL-6 and stabilisation of the haemodynamic profile. Chinese Clinical Trials Register Identifier: ChiCTR-IPR-17010881.

Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis.

Common complications of pediatric strabismus surgery, including emergence agitation (EA), postoperative nausea and vomiting (PONV), and postoperative pain, may be prevented using dexmedetomidine, which is an anxiolytic and analgesic. This systematic review and meta-analysis assessed the effects of dexmedetomidine in patients who had undergone pediatric strabismus surgery. Five databases were searched for randomized controlled trials published from database inception to April 2020 that compared dexmedetomidine use with placebo or active comparator use and evaluated EA, PONV, or postoperative pain incidence (main outcomes) in patients who had undergone pediatric strabismus surgery. Oculocardiac reflex (OCR) incidence and postanesthesia care unit (PACU) stay duration were considered as safety outcomes. All meta-analyses were performed using a random-effects model. In the nine studies meeting our inclusion criteria, compared with placebo use, dexmedetomidine use reduced EA incidence [risk ratio (RR): 0.39; 95% confidence interval (CI): 0.25-0.62, I2 = 66%], severe EA incidence (RR: 0.27, 95% CI: 0.17-0.43, I2 = 0%), PONV incidence (RR: 0.33, 95% CI: 0.21-0.54, I2 = 0%), analgesia requirement (RR: 0.38, 95% CI: 0.25-0.57, I2 = 0%), and pain scores (standardized mean difference: -1.02, 95% CI: -1.44 to -0.61, I2 = 75%). Dexmedetomidine also led to lower EA incidence in the sevoflurane group than in the desflurane group (RR: 0.26 for sevoflurane vs. 0.45 for desflurane). Continuous dexmedetomidine infusion (RR: 0.19) led to better EA incidence reduction than did bolus dexmedetomidine infusion at the end of surgery (RR: 0.26) or during the peri-induction period (RR: 0.36). Compared with placebo use, dexmedetomidine use reduced OCR incidence (RR: 0.63; I2 = 40%). No significant between-group differences were noted for PACU stay duration. In patients who have undergone pediatric strabismus surgery, dexmedetomidine use may alleviate EA, PONV, and postoperative pain and reduce OCR incidence. Moreover, dexmedetomidine use does not affect the PACU stay duration.

Clonidine as an Adjuvant to Bupivacaine for Suprazygomatic Maxillary Nerve Blocks in Cleft lip and Palate Repair: A Randomized, Prospective, Double-Blind Study.

Does clonidine, as adjuvant to bupivacaine for suprazygomatic maxillary nerve blocks, reduce emergence agitation in patients undergoing cleft lip and cleft palate surgery? Randomized, controlled, and double-blind study. Guwahati Comprehensive Cleft Care Center, Guwahati (Assam, India). A total of 124 patients; with a median age of 5 years in the clonidine group (CLG) and 7 years in the control group (CG), who underwent cleft lip or cleft palate surgery were included. Exclusion criteria included lack of consent from patients or their guardians, allergy to local anesthetics, coagulation disorders, local infection at the puncture site before performing the block, and language difficulties or cognitive disorders. Patients were randomized into 2 groups to receive bilateral suprazygomatic maxillary nerve blocks with either a bupivacaine/clonidine mixture for the CLG or bupivacaine alone in the CG. The primary end point was the incidence of emergence agitation. There was a statistically significant difference in the incidence of emergence agitation (30.2% in the CG compared to 15.2% in the CLG; difference of incidences: 15%, 95% CI: 0.1-30.1). The percentage of patients requiring intraoperative Fentanyl was lower in the CLG (10.6% compared to 26.4%; difference of incidences: 15.8%, 95% CI: 1.8-29). No other differences were observed. Further research in a more typically aged children population undergoing cleft surgery is needed. The use of clonidine as an adjuvant to bupivacaine in maxillary nerve block reduces the incidence of emergence agitation and intraoperative opioid consumption without hemodynamic or sedative side effects in patients undergoing cleft lip and palate surgery.

Effects of Adding a Combined Infraorbital and Infratrochlear Nerve Block to General Anaesthesia in Septorhinoplasty.

PurposeIn this study, we evaluated the hypothesis that preoperative bilateral infraoptic nerve (ION) and infratrochlear nerve (ITN) blocks under general anesthesia with sevoflurane and remifentanil reduced the incidence of emergence agitation (EA), pain scores, and the analgesic consumption after the septorhinoplasty.Patients and MethodsOur study was conducted as a prospective randomized, double-sided blind study. Fifty-two patients whose septorhinoplasty operation was planned under general anesthesia were included in the study. Patients were randomly distributed to either the ION and ITN blocks were performed. Group 1: Bilateral ION and ITN blocks were performed; Group 2: ION and ITN blocks were not performed. Duration of the surgery and anesthesia, Riker Sedation-Agitation Scale (RSAS) score, EA presence, duration of postoperative analgesia, numerical rating scale (NRS) scores, and cumulative dexketoprofen consumption were recorded.ResultsThe RSAS score, NRS score and cumulative dexketoprofen consumption of the patients in Group 1 were statistically significantly lower than the patients in Group 2 (p<0.05). It was also found that patients in Group 1 (n: 8/26) had less EA compared to patients in Group 2 (n: 16/26) and this difference was statistically significant (p: 0.026). Postoperative analgesia duration of patients in Group 1 was found to be statistically significantly higher than patients in Group 2 (p: <0.001). In addition, the number of patients given postoperative dexketoprofen in Group 1 (n: 8/26) was found to be statistically significantly lower than patients in Group 2 (n: 25/26). (p: <0.001).ConclusionBilateral ION and ITN blocks in septorhinoplasty operation is an effective, reliable and simple technique in the treatment of postoperative pain.

Intranasal dexmedetomidine versus intranasal midazolam as pre-anesthetic medication in pediatric age group undergoing adenotonsillectomy

BackgroundThe pre-operative period is a very stressful event for most of the individuals undergoing surgery especially the pediatric patients. So, relieving their pre-operative anxiety becomes an important concern for an anesthesiologist. Many anesthetic pre-medications are used to relieve this stress response. Of these pre-medications, midazolam and dexmedetomidine are effectively used as sedatives. The present study was planned to compare intranasal dexmedetomidine with intranasal midazolam as a pre-anesthetic medication in children. Forty-eight children aged 3–7 years, of either sex, weighing 13–22 kg, with American Society of Anesthesiologists (ASA) physical status 1 and undergoing elective adenotonsillectomy surgery were enrolled in this comparative prospective, double blinded, randomized clinical study. The children were divided into 2 groups: group D and group M, of 24 each. Forty-five minutes before induction of anesthesia, group D (n = 24) received intranasal dexmedetomidine at a dose of 1 μg/kg and group M (n = 24) received intranasal midazolam of 0.2 mg/kg.ResultsChildren who were pre-medicated with dexmedetomidine had lower sedation scores, lower anxiety levels, easier child-parent separation, better mask acceptance, and lower pain scores than those who received midazolam. The incidence of emergence agitation was decreased in both groups with no significant difference.ConclusionIntranasal dexmedetomidine seems to offer some advantages compared with midazolam. Thus, it can be used effectively and safely as a pre-anesthetic medication in children undergoing any surgical procedures under general anesthesia.

The Addition of Intravenous Propofol and Ketorolac to a Sevoflurane Anesthetic Lessens Emergence Agitation in Children Having Bilateral Myringotomy with Tympanostomy Tube Insertion: A Prospective Observational Study.

The aim of this prospective observational study was to determine if children undergoing bilateral myringotomy and tympanostomy tube insertion with a sevoflurane anesthetic plus intravenous propofol and ketorolac experienced a lower incidence of emergence agitation than those receiving a sevoflurane anesthetic alone. Duration of procedure, length of stay in post-anaesthesia care and level of nursing effort required to care for patients were also assessed. In this study, 49 children younger than 13 years of age received a sevoflurane anesthetic. Fifty-one percent of these patients also received a single injection of propofol 1 mg/kg and ketorolac 0.5 mg/kg at the end of the procedure. Patients were assessed for emergence agitation using the Pediatric Anesthesia Emergence Delirium scale in the post-anaesthesia care unit. Four children receiving a sevoflurane anesthetic alone experienced emergence agitation, while no children receiving propofol and ketorolac experienced emergence agitation (p = 0.05). The length of stay until discharge from the hospital was 6.98 min longer for patients receiving propofol and ketorolac but did not reach statistical significance (p = 0.23). Nurses reported greater ease in caring for patients receiving the propofol and ketorolac injection (recovery questionnaire score 4.50 vs. 3.75, p = 0.002). In this study, adding a single injection of intravenous propofol and ketorolac to the end of a brief sevoflurane anesthetic for bilateral myringotomy with tube insertion was associated with a lower incidence of emergence agitation without significantly increasing the time to discharge from the hospital.

Comparison of Intravenous Ketamine and Midazolam Premedication on Emergence Agitation (EA) in Children following Tonsillectomy with or without Adenoidectomy under General Anaesthesia

Background: Management of emergence agitation (EA) following tonsillectomy with or without adenoidectomy under general anaesthesia in children has been a major challenge for anaesthesiologists.Several medications have been investigated in an attempt to reduce the occurrence and severity of EA. Objectives: The purpose of this study is to determine the effect of premedication with intravenousmidazolam and ketamine on EA following tonsillectomy with or without adenoidectomy under generalanaesthesia in children. Study design: Randomised clinical study. Methods: Sixty children of both sex, American Society of Anaesthesiologists (ASA) physical status I &amp; IIage 5 to 12 years scheduled to undergo elective tonsillectomy with or without adenoidectomy were randomlyassigned into two groups. Patients in group K (n=30) received premedication of intravenous ketamine0.25 mg/kg body weight in 5 ml total volume and in group M (n=30) received premedication 0.1 mg/kgbody weight intravenous midazolam in 5 ml total volume. After completion of surgery patients weretransferred to recovery. Incidences and severity of EA(Paediatric Anaesthesia Emergence Delirium Scale),pain score (Wong-Baker FACES Pain scale) and postoperative nausea and vomiting (PONV) were assessedat admission in the recovery (T0) and in the post anaesthesia care unit (PACU) at 5 min (T5), at 15 min(T15) and at 30 min (T30). Results: Incidences of EA in Group K remained significantly lower than Group M at admission to therecovery and in the PACU at 5 min and 15 min (P&lt;0.05). Severity of EA was significantly lower patientsin Group K than Group M at admission in recovery and in PACU at 5 minute and 15 minute (P&lt;0.05).There were no significant differences in pain scores between two groups. Regarding PONV there was nosignificant difference between two groups. Conclusion: Premedication with ketamine was more effective than midazolam in the prevention of EAfollowing tonsillectomy with or without adenoidectomy in pediatric patients under general anaesthesia. JBSA 2020; 33(2): 55-61

Comparison between Dexmedetomidine or Magnesium Sulfate as Adjuvants to Bupivacaine for Caudal Anesthesia in Pediatric Patients Undergoing Infraumbilical Surgeries

Background: Caudal epidural anesthesia is a common technique providing intra and postoperative analgesia in pediatric infraumbilical surgical procedures. Objectives: The aim of this study was to compare the effect of adding Dexmedetomidine or Magnesium Sulfate as an adjuvant to Bupivacaine for caudal anesthesia in pediatric infraumbilical surgeries. Patients and Methods: This randomized controlled prospective study was done at Sohag University Hospital on sixty pediatric patients with American Society of Anesthesiologists (ASA) Classes I or II or III, weighted up to 20 kg scheduled for infraumbilical surgeries using caudal block in the period between January 2019 and January 2020. The included subjects were divided into three groups, twenty patients each: Group C (control), Group D (Dexmedetomidine group) and Group M (Magnesium group). Results: In our study, the caudal block mainly used to relieve pain after Sevoflurane anesthesia with less incidence of emergence agitation. On comparing (Group D) and (Group M), Face, Legs, Activity, Cry, Consolability scale (FLACC) score was lower in (Group D: 0,1,1,2) than (Group M: 1,1,2,2) without significant difference at postoperative set times (30 minutes,1,2,3 hours), respectively. At the 6th hour postoperatively, (Group M) patients achieved higher FLACC scores (3) compared with (Group D) patients (2.5) with statistically significant difference with P value of 0.05. During the first 3 hours post-operative, there were higher sedation scores in (Group D: 4,4,3,3) and (Group M: 4,4,3,2.5) more than (Control group: 3,2.5,2,2) with highly statistical significant difference with (P value < 0.001) at (30 minutes,1h, 2h, 3 hours), respectively. At the 6th hour postoperatively, there were higher sedation scores with (Group D) (3) more than (Group M) (2) with highly statistical significant difference with (P value < 0.001). Conclusion: Administration of Dexmedetomidine as adjuvant with Bupivacaine enhances caudal block, prolongs duration of postoperative analgesia, reduces postoperative EA and provides preferred postoperative sedation in pediatric patient undergoing infraumbilical surgeries with minimum adverse effects compared to Magnesium Sulfate as adjuvant.

Comparison between Dexmedetomidine or Magnesium Sulfate as Adjuvants to Bupivacaine for Caudal Anesthesia in Pediatric Patients Undergoing Infraumbilical Surgeries

Background: Caudal epidural anesthesia is a common technique providing intra and postoperative analgesia in pediatric infraumbilical surgical procedures. Objectives: The aim of this study was to compare the effect of adding Dexmedetomidine or Magnesium Sulfate as an adjuvant to Bupivacaine for caudal anesthesia in pediatric infraumbilical surgeries. Patients and Methods: This randomized controlled prospective study was done at Sohag University Hospital on sixty pediatric patients with American Society of Anesthesiologists (ASA) Classes I or II or III, weighted up to 20 kg scheduled for infraumbilical surgeries using caudal block in the period between January 2019 and January 2020. The included subjects were divided into three groups, twenty patients each: Group C (control), Group D (Dexmedetomidine group) and Group M (Magnesium group). Results: In our study, the caudal block mainly used to relieve pain after Sevoflurane anesthesia with less incidence of emergence agitation. On comparing (Group D) and (Group M), Face, Legs, Activity, Cry, Consolability scale (FLACC) score was lower in (Group D: 0,1,1,2) than (Group M: 1,1,2,2) without significant difference at postoperative set times (30 minutes,1,2,3 hours), respectively. At the 6th hour postoperatively, (Group M) patients achieved higher FLACC scores (3) compared with (Group D) patients (2.5) with statistically significant difference with P value of 0.05. During the first 3 hours post-operative, there were higher sedation scores in (Group D: 4,4,3,3) and (Group M: 4,4,3,2.5) more than (Control group: 3,2.5,2,2) with highly statistical significant difference with (P value < 0.001) at (30 minutes,1h, 2h, 3 hours), respectively. At the 6th hour postoperatively, there were higher sedation scores with (Group D) (3) more than (Group M) (2) with highly statistical significant difference with (P value < 0.001). Conclusion: Administration of Dexmedetomidine as adjuvant with Bupivacaine enhances caudal block, prolongs duration of postoperative analgesia, reduces postoperative EA and provides preferred postoperative sedation in pediatric patient undergoing infraumbilical surgeries with minimum adverse effects compared to Magnesium Sulfate as adjuvant.

Effect of recorded maternal voice on emergence agitation in children undergoing bilateral ophthalmic surgery: A randomised controlled trial.

This study was designed to investigate whether the playing-back of the recorded maternal voice through the headphones to children undergoing bilateral ophthalmic surgery has clinical effects on the incidence of emergence agitation, and the anaesthesia recovery course. In this prospective, blinded and randomised study, 127 children, aged 2-8 years and undergoing bilateral ophthalmic surgery were randomly allocated to one of the two groups: group T (treatment group, listening to recorded mother's voice via headphones) or group C (control group, wearing headphones without auditory stimuli). The primary outcome was the incidence of emergence agitation, and the secondary outcomes were the awakening time, and the post-anaesthesia care unit (PACU) stay time. Children in the group of listening recorded mother's voice exhibited significantly low incidence of emergence agitation compared with those in the control group (32.8 vs. 55.6%; odds ratio (95% confidence interval): 0.39(0.19-0.80); P = 0.010). The awakening time was shorter in group T as compared to that in group C (22.9 (10.4) vs. 27.3 (13.7); P = 0.048). As results, the group T had significantly less PACU stay time with early discharge than the group C did (29.7 (12.1) vs. 34.8 (14.1); P = 0.031). Recorded mother's voice is an efficient method to reduce emergence agitation in children undergoing bilateral ophthalmic surgery with sevoflurane anaesthesia. Also, patients woke faster and PACU stay time was shorter in the mother's voice group as compared with the control group.

Risk Factors for Emergence Agitation in Adults Undergoing Thoracoscopic Lung Surgery: A Case-Control Study of 1,950 Patients

The present study investigated the incidence of and risk factors for emergence agitation (EA) in adult patients after thoracoscopic lung surgery. A retrospective case-control study. Single-center university hospital. The study comprised 1,950 adult patients who underwent elective lung surgery from January to December 2016. None. Preoperative, surgical, and anesthesia-related data were collected. EA was assessed with the Riker Sedation-Agitation Scale and defined as a Riker score ≥5. Univariate analyses and multivariate logistic regression analysis were used to identify risk factors for EA. The incidence of EA was 14.1%. The results of the multivariate analysis showed that male sex (odds ratio [OR] 1.877, 95% confidence interval [CI] 1.341-2.627), age ≥65 years (OR 1.424, 95% CI 1.074-1.889), body mass index ≥24 kg/m2 (OR 1.409, 95% CI 1.070-1.856), American Society of Anesthesiologists physical status Ⅲ or Ⅳ (OR 2.654, 95% CI 1.189-5.924), cigarette smoking (OR 1.553, 95% CI 1.108-2.177), duration of surgery (OR 1.006, 95% CI 1.003-1.009), intraoperative tachycardia (OR 1.721, 95% CI 1.058-2.802), intraoperative hypotension (OR 1.636, 95% CI 1.064-2.514), intraoperative hypertension (OR 1.608; 95% CI 1.056-2.448), and rescue analgesia (OR 1.810, 95% CI 1.235-2.653) were independent risk factors for EA. However, wound infiltration (OR 0.679, 95% CI 0.507-0.908) and the use of dexmedetomidine (OR 0.663, 95% CI 0.490-0.869) appeared to be protective factors against EA. EA is a common complication after thoracoscopic lung surgery, especially within a certain population. Adequate perioperative management, which comprises wound infiltration, the maintenance of intraoperative hemodynamic stability, sufficient analgesia, and the use of dexmedetomidine, should be adopted to reduce the incidence of EA.

Intranasal dexmedetomidine premedication in children with recent upper respiratory tract infection undergoing interventional cardiac catheterisation: A randomised controlled trial.

Recent upper respiratory tract infection (URI) is a risk factor for the occurrence of peri-operative respiratory adverse events (PRAE). This risk may be higher in children with congenital heart disease (CHD), particularly in those undergoing interventional cardiac catheterisation. It is therefore essential to adapt the anaesthetic strategy in these children to prevent from the occurrence of PRAE. To determine whether intranasal dexmedetomidine (DEX) premedication can reduce the incidence of PRAE in children with recent URI undergoing interventional cardiac catheterisation. Randomised controlled trial. Single-centre study based at a tertiary care centre in Shanghai, China. A total of 134 children with CHD aged 0 to 16 years with recent URI undergoing interventional cardiac catheterisation. Children were randomised to receive either intranasal DEX 1.5 μg kg (DEX group) or intranasal saline (Placebo group) 30 to 45 min before anaesthesia induction. The incidence of PRAE. Intranasal DEX significantly reduced the incidence of PRAE (P = 0.001), particularly oxygen desaturation (P = 0.012). Most PRAE were observed during the emergence phase. The incidence of PRAE was comparable among the three types of left-right shunt CHD children in both groups. In children aged less than 3 years, the incidence of PRAE was significantly lower in the DEX group (P = 0.003). In contrast, the incidence of PRAE was comparable between the two groups in children aged at least 3 years. No differences in the incidence of emergence agitation, fever and vomiting between the two groups were noted. Administration of intranasal DEX 1.5 μg kg 30 to 45 min before induction led to a reduction in the incidence of PRAE in children aged less than 3 years with recent URI undergoing interventional cardiac catheterisation. chictr.org.cn identifier: ChiCTR-RRC-17012519.

Effects of Lidocaine Infusion on Quality of Recovery and Agitation after Functional Endoscopic Sinus Surgery: Randomized Controlled Study

Background: After functional endoscopic nasal surgery, emergence agitation is not uncommon. The aim of this trial was to investigate the effect of perioperative lidocaine infusion on postoperative early recovery quality and incidence of emergence agitation in patient undergoing functional endoscopic sinus surgery. Study Design: Prospective, randomized, double-blinded, placebo-controlled trial. Methods: 100 patients of ASA I and II, aged 18 - 50 years, of both sexes scheduled for FEES, were assigned into two groups. In Group L; patients received an intravenous bolus infusion of 1.5 mg/kg lidocaine just before induction of anesthesia followed by a continuous infusion of 2 mg/kg/h during the operation and until the end of the surgery. In Group C; patients received normal saline infusion with the same volume as group L according to the same protocol. The primary endpoints were incidence of emergence agitation and postoperative recovery quality (QoR-40) score on first postoperative day (POD1). Results: Incidence of emergence agitation was significantly lower in group L (P 0.05) compared with group C. Global QoR-40 scores on POD1 were significantly lower in both groups compared with preoperative assessment, it was significantly higher in group L on POD1 (P 0.05) than in group C. Among the five dimensions of QoR-40, the scores for physical comfort and pain were superior in group L compared to group C (P 0.05) at POD1. Conclusion: Systemic lidocaine infusion can improve QoR-40 scores and decrease incidence of emergence agitation in patients scheduled for FEES, also it reduces the duration of stay in PACU after surgery.

Tracheal extubation of anesthetized pediatric patients with heart disease decreases the incidence of emergence agitation: A retrospective study.

Background:Emergence agitation for pediatric patients after general anesthesia is one of the postoperative complications. The relationship between consciousness at tracheal extubation and emergence agitation is not clear.Aim:The aim of the present study was to determine whether tracheal extubation of anesthetized pediatric patients with heart disease by propofol decreases the incidence of emergence agitation.Settings and Design:This was a retrospective case-control study conducted at a children's hospital.Materials and Methods:Pediatric patients with heart disease aged 0-14 years who underwent cardiac catheterization under general anesthesia by propofol between October 2014 and September 2018 were enrolled. The incidence of emergence agitation by anesthetized extubation was compared with that by awake extubation.Statistical Analysis Used:Logistic regression analysis was performed.Results:Anesthetized extubation was performed in 202 patients and awake extubation was performed in 56 patients. The incidence of emergence agitation was significantly lower in patients who underwent anesthetized extubation than in patients who underwent awake extubation (25.2% vs. 69.6%, P = 0.000). In logistic regression analysis, anesthetized extubation [odds ratio (OR): 0.075, 95% confidence interval (CI): 0.034-0.165, P = 0.000] and older age (OR: 0.808, 95% CI: 0.728-0.897, P = 0.000) were associated with a decreased incidence of emergence agitation, and preoperative anxiety (OR: 2.220, 95% CI: 1.060-4.660, P = 0.03) was associated with an increased incidence of emergence agitation.Conclusions:Tracheal extubation under anesthesia by propofol decreases the incidence of emergence agitation in pediatric patients with heart disease.

Efficacy of 0.5 mg/kg of propofol at the end of anesthesia to reduce the incidence of emergence agitation in children undergoing general anesthesia with sevoflurane.

Background and Aims:Emergence agitation (EA) is a common transient behavioral disturbance after inhalational anesthesia and may cause harm to the patient. This study evaluated the efficacy of 0.5 mg/kg of propofol administered at the end of anesthesia to reduce the incidence of EA in children undergoing general inhalational anesthesia.Material and Methods:This double-blind randomized clinical trial was done in children aged 1–5 years undergoing general anesthesia with sevoflurane. One hundred and eight subjects were included using consecutive sampling method and randomized into two equal groups. Propofol in the dose of 0.5 mg/kg was administered at the end of anesthesia to children in the propofol group, while those in the control group did not receive any intervention at the end of anesthesia. Incidence of EA, transfer time, postoperative hypotension, desaturation, and nausea-vomiting were observed. Aono and Pediatric Anesthesia Emergence Delirium scale were used to assess EA.Results:Incidence of EA was 25.9% in the propofol group compared to 51.9% in the control group (RR = 0.500; 95% CI 0.298–0.840; P = 0.006). Mean transfer time in propofol group was longer (9.5 ± 3.9 min) than control group (7.8 ± 3.6 min) (mean difference 1.71 min; 95% CI 0.28–3.14; P = 0.020). Hypotension was found in one patient (1.9%) in propofol group, while in control group there was none. Nausea-vomiting was found in five patients (9.3%) in propofol group and eight patients (14.8%) in control. There was no desaturation in both the groups.Conclusion:Administration of 0.5 mg/kg of propofol at the end of anesthesia effectively reduces the incidence of EA in children undergoing general inhalational anesthesia with sevoflurane.

A comparison of intranasal ketamine, intranasal dexmedetomidine, and their combination as premedication in pediatric patients undergoing cardiac catheterization

Background Minimizing preoperative anxiety and facilitating parental separation may be of particular importance in pediatric patients undergoing cardiac catheterization. This prospective randomized study was conducted to compare intranasal ketamine, intranasal dexmedetomidine, and their combination as sedative premedications in pediatric patients undergoing cardiac catheterization. Patients and methods Ninety pediatric patients aged between 2 and 4 years scheduled for interventional cardiac catheterization under general anesthesia were included in the study and were randomized to receive intranasal ketamine 5 mg/kg, intranasal dexmedetomidine 2 µg/kg, or a combination of intranasal dexmedetomidine 1 µg/kg plus ketamine 3 mg/kg. The primary outcome of the study was children’s behavior during venous cannulation. The secondary outcomes were onset of sedation, behavior at parental separation, propofol consumption during the procedure, recovery time, incidence of postoperative agitation, and other adverse events. Results The number of patients who had satisfactory venipuncture score was significantly higher in group K (83.3%) and group DK (82.7%) than in group D (55.1%). The onset of sedation was significantly faster in group K (8.37±2.8 min) and group DK (16.7±5.9 min) than in group D (26.8±7.6 min). The number of patients who had satisfactory parental separation was comparable among the studied groups. The incidence of emergence agitation and excessive salivation were significantly higher in group K compared with group D and group DK; meanwhile, the incidence of bradycardia was significantly higher in group D compared with group K and group DK. Conclusion Using a combination of intranasal ketamine and dexmedetomidine was associated with significantly more satisfactory venous cannulation conditions and faster onset of sedation than using intranasal dexmedetomidine alone. The combination was also associated with less adverse events than using either drug alone.

The comparison of effects of thiopental and ketofol on emergence agitation in patients with nasal surgery: A prospective, single-blind, randomized clinical trial

Aim: Emergence agitation (EA) is a postanesthetic phenomenon that is common in patients who undergo nasal surgery with general anesthesia, which manifests itself with confusion and violent behaviors and may cause serious problems such as bleeding in the surgical site, unplanned removal of catheter or endotracheal tube. In this study, we aimed to compare the effect of thiopental and ketofol on EA formation after nasal surgery.Material and Methods: This study was performed as a prospective, randomized, single-blind, clinical trial in 80 patients undergoing nasal surgery. The patients were randomly divided into two groups as thiopental (group P:40) and ketofol (group K:40). As the primary outcome; Riker Sedation Agitation Scale (RSAS) was used in order to evaluate EA at the 5th minute after extubation. As the secondary outcome; we aimed to evaluate predisposing factors causing EA.Results: The mean age of the patients was 38.55±13.12 in Group P, while it was 40.68±11.88 in Group K. The incidence of emergence agitation (EA) was significantly higher in Group P than in Group K. There was a statistically significant difference between the two groups (Group P:12 cases (30%), Group K:1 case (2.5%), P:0.001). Residual sedation values in PACU were similar in both groups (P:0.248). The duration of stay in PACU was significantly lower in Group P (P:0.001). Duration of anesthesia, duration of surgery, time to extubation and time to verbal response times were similar in both groups. There was no statistically significant difference between the groups.Conclusion: In patients who underwent nasal surgery under general anesthesia; using ketofol instead of thiopental can significantly reduce EA.

Comparison of recovery characteristics with two different washout techniques of desflurane anaesthesia: A randomised controlled trial.

Background:Rapid emergence with low soluble inhalational agents (IA) is offset by a significant association with emergence agitation (EA). Research on the influence of elimination methods of IA on recovery characteristics is very few. We conducted this study to compare the recovery characteristics of slow elimination (SE) of desflurane with purging technique.Methodology:Forty-five participants, 18–60 years, undergoing elective laparoscopic surgeries were randomised either into Group-P (n = 23) or Group-SE (n = 22). A standardised induction-maintenance protocol including desflurane and fresh gas flow (FGF) of 0.8 l/min was followed. During recovery, the FGF was increased in Group-P to 10 L/min and in Group-SE it was continued at 0.8 L/min. The decrement in end-tidal concentration of desflurane, time for emergence and extubation, EA and time for psychomotor recovery were noted.Results:Time for emergence (Group-SE: 22.8 ± 9 vs. Group-P: 5.6 ± 1.5 min; P = 0.000) and emergence to extubation duration (Group-SE: 128 ± 36 s vs. Group-P: 11.5 ± 1.7 s; P = 0.000) were longer in the Group-SE than in Group-P. EA occurred in 22.7% patients in Group-SE and in 4.3% patients in Group-P (P = 0.07). Psychomotor recovery to baseline values was seen in more number of patients in Group-SE than Group-P at 30 min. There was no difference between the groups at 60 min post-extubation.Conclusions:Slow elimination using FGF of 0.8 L/min significantly prolongs emergence even with low soluble agent like desflurane. SE is not beneficial in decreasing the incidence of EA or hastening psychomotor recovery. Purging technique is, therefore, a better-suited technique with fewer complications for eliminating desflurane.

Comparison of emergence agitation between succinylcholine and rocuronium-sugammadex in adults following closed reduction of a nasal bone fracture: a prospective randomized controlled trial

BackgroundSugammadex allows rapid recovery from rocuronium-induced neuromuscular blockade. Succinylcholine is often used for brief surgeries but is associated with myalgia, headache, histamine release, and increased lactate levels. Thus, we hypothesized that succinylcholine may affect emergence agitation (EA) and compared the effects of succinylcholine and rocuronium-sugammadex on EA in patients undergoing closed reduction of a nasal bone fracture under general anesthesia.MethodsForty-two patients were prospectively enrolled and allocated randomly to the succinylcholine group (group SC) or the rocuronium-sugammadex group (group RS; each n = 21). Neuromuscular block and its reversal were achieved with succinylcholine and normal saline in group SC, whereas rocuronium and sugammadex were administered in group RS. After surgery, the incidence of EA as a primary outcome, the incidence of dangerous EA, and duration of EA as secondary outcomes were compared.ResultsThe incidence of EA was higher in group SC than in group RS (90.5% vs. 47.6%, respectively; relative risk [RR] 4.3; 95% confidence interval [CI] 1.2 to 15.7; P = .006). The incidence of dangerous EA increased in group SC compared to group RS (33.3% vs. 4.8%, respectively; RR 2.1; 95% CI 1.3 to 3.4; P = .045). The duration of agitation was longer in group SC than in group RS [106.5 (65.1) vs. 40.4 (26.0) sec; mean difference 66.1 s; 95% CI 31.0 to 101.1; effect size 1.3; P = .001).ConclusionSuccinylcholine increases the incidence, severity, and duration of EA compared to rocuronium-sugammadex in patients undergoing closed reduction of a nasal bone fracture.Trial registrationCRiS Registration number KCT0002673. Initial registration date was 31 January 2018 (Retrospectively registered).