Effects of tramadol on emergence agitation after general anesthesia for nasal surgery

INTRODUCTION Postoperative agitation or emergence agitation during recovery from anesthesia is an important complication of General Anesthesia (GA) especially in otolaryngological surgeries, and nasal surgery in particular. It is potentially harmful to the patients resulting in fall from the operation table, self-extubation, self-removal of nasal pack, hemorrhage etc. Several methods and medications have been tried to reduce it. We studied the effect of anterior ethmoidal nerve block for reducing post-operative agitation for nasal surgeries with nasal packs as it falls in the same operative field. MATERIAL AND METHODS A total of 100 participants undergoing nasal surgeries with nasal pack under GA in the Department of Otolaryngology, Lumbini Medical College, Palpa, Nepal, were randomized into cases and controls by block randomization. The study was done from June 2018 till February 2020. Anterior ethmoidal nerve was blocked with lidocaine injection at the end of surgery in cases. Controls were injected with normal saline. Post-operative agitation was studied with Riker Sedation-Agitation Scale (SAS) and was compared between the two groups. RESULTS There were 50 participants in each group. Emergence agitation in cases and controls at extubation, 30 minutes post-extubation and the next morning was present in 32% and 52%, 4% and 18%, and 0 and 2% respectively. SAS score rapidly decreased in 30 minutes after extubation in controls but was still significantly higher than that of cases. CONCLUSION Anterior ethmoidal nerve block was effective in reducing post-operative agitation significantly during emergence in nasal surgeries with nasal packs.

Download Full-text

Can Dexmedetomidine Influence Recovery Profiles from General Anesthesia in Nasal Surgery?

Otolaryngology ◽

10.1177/0194599817733735 ◽

2017 ◽

Vol 158 (1) ◽

pp. 43-53 ◽

Cited By ~ 8

Author(s):

Ho Seok Lee ◽

Ho Young Yoon ◽

Ho Jun Jin ◽

Se Hwan Hwang

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

General Anesthesia ◽

Meta Analysis ◽

Nausea And Vomiting ◽

Intraoperative Blood Loss ◽

Emergence Agitation ◽

Nasal Surgery ◽

Surgical Time ◽

Inhaled Anesthetic

Objectives Dexmedetomidine has sympatholytic, sedative, anesthetic, and analgesic effects, as well as vasoconstrictive effects, which may help prevent hypotension under general anesthesia. This meta-analysis aimed to perform a systematic review of the literature and investigate the effect of dexmedetomidine on perioperative morbidity following nasal surgery and its adverse effects. Data Sources MEDLINE, SCOPUS, and the Cochrane database. Review Methods Two authors independently searched the databases from their inception to March 2017. Studies were selected that compared perioperative dexmedetomidine administration (dexmedetomidine groups) with a placebo or remifentanil (control groups) with regard to intraoperative morbidity, including surgical time, bleeding amount, hypotension, and bradycardia during operation, and postoperative morbidity, such as emergence agitation, nausea and vomiting, and sedation after operation. Results Surgical time, intraoperative blood loss, dose of inhaled anesthetic gas, dose of fentanyl, postoperative pain, and incidence of emergence agitation were significantly lower in the dexmedetomidine group versus the placebo group. In contrast, there were no significant differences in intraoperative hemodynamic stability and postoperative residual sedation and nausea and vomiting between groups. Additionally, compared with remifentanil (a currently widely used agent), dexmedetomidine was superior in view of postoperative pain and intraoperative blood pressure control. Conclusion This meta-analysis shows that the systemic administration of dexmedetomidine can decrease surgical time, intraoperative blood loss, and doses of intraoperative inhaled anesthetic gas and fentanyl as compared with placebo. It can also decrease postoperative pain and incidence of the emergence agitation. Due to the small number of studies, further clinical trials are needed to confirm these results.

Download Full-text

Effects of nefopam on emergence agitation after general anesthesia for nasal surgery

Medicine ◽

10.1097/md.0000000000008843 ◽

2017 ◽

Vol 96 (47) ◽

pp. e8843 ◽

Cited By ~ 4

Author(s):

Young Seok Jee ◽

Hwang-Ju You ◽

Tae-Yun Sung ◽

Choon-Kyu Cho

Keyword(s):

General Anesthesia ◽

Emergence Agitation ◽

Nasal Surgery

Download Full-text

Risk factors for emergence agitation in adults after general anesthesia: a systematic review and meta‐analysis

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.13774 ◽

2020 ◽

Author(s):

Bing Wei ◽

Yan Feng ◽

Wenjuan Chen ◽

Dapeng Ren ◽

Daishun Xiao ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

General Anesthesia ◽

Meta Analysis ◽

Emergence Agitation

Download Full-text

Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Older Than 60 Years: A Retrospective Study

Ear Nose & Throat Journal ◽

10.1177/01455613211033112 ◽

2021 ◽

pp. 014556132110331

Author(s):

Yong Won Lee ◽

Bum Sik Kim ◽

Jihyun Chung

Keyword(s):

General Anesthesia ◽

Incidence Rate ◽

Urinary Retention ◽

Nasal Surgery ◽

Prostate Hyperplasia ◽

Postoperative Urinary Retention ◽

Asa Classification ◽

History Of ◽

Male Patients ◽

Endoscopic Nasal Surgery

Objectives: Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. Methods: A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. Results: Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR ( P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. Conclusions: General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient’s urological history and urinary conditions appear to affect the occurrence of POUR.

Download Full-text

Risk factors for emergence agitation in adults after general anesthesia: A meta-analysis from observational studies

10.37766/inplasy2020.7.0032 ◽

2020 ◽

Author(s):

Bing Wei ◽

Yan Feng ◽

Wen Chen ◽

Da Ren ◽

Dai Xiao ◽

...

Keyword(s):

Risk Factors ◽

General Anesthesia ◽

Observational Studies ◽

Meta Analysis ◽

Emergence Agitation

Download Full-text

The Effect of Subtenons Lidocaine on Emergence Agitation after General Anesthesia in Pediatric Strabismus Surgery

European Scientific Journal ESJ ◽

10.19044/esj.2016.v12n6p48 ◽

2016 ◽

Vol 12 (6) ◽

pp. 48

Author(s):

Agolli. L ◽

Shuteriqi. B

Keyword(s):

General Anesthesia ◽

Normal Saline ◽

Recovery Room ◽

Eye Contact ◽

Saline Group ◽

Strabismus Surgery ◽

Emergence Agitation ◽

Surrounding Environment ◽

Lidocaine Injection ◽

In The Beginning

Objectives: To study the effect of subtenon lidocaine injection at the end of intervention on the post-operative emergence agitation in pediatric strabismus surgery under general anesthesia with sevofluran. Material: We studied 191 children patients undergoing muscle surgery for strabismus from 2-6 years old. Children were (prospectively) randomized to one of the four groups. These groups include: A –Group Sevofluran fentanyl; B –Group sevoflurane fentanyl, Subtenon lidocaine injection; C – Group Propofol, fentanyl, sevofluran; and D – Group Propofol, fentanyl, Sevoflurane, Subtenon lidocaine injection. In the beginning of the induction of anesthesia, children received dexametasone and metoclopropamide. At the end of the surgery, children received either lidocaine (2%) or normal saline (1ml) into the subtenons space. This was conducted on the recovery room using five scoring scale. These scale include: 1- the child makes eye contact, 2- Purposeful response after repeated stimuli, 3 – the child is aware of the surrounding environment, 4- severe restlessness, and 5 – The child is inconsolable. The degree of emergence agitation was observed. Furthermore, the score 4 and 5 was considered as an emergence agitation. Results: There are no differences regarding age and weight. The incidence of emergence agitation was significantly lower in the groups which were receiving subtenon lidocaine compared with saline group injections (p< 0.05). Conclusions: A lidocaine injection into subtenon space reduces the emergence agitation after general anesthesia in pediatric strabismus surgery.

Download Full-text

Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Over 60 Years: A Retrospective Study

10.21203/rs.3.rs-43524/v1 ◽

2020 ◽

Author(s):

Yong Won Lee ◽

Bum Sik Kim ◽

Jihyun Chung

Keyword(s):

General Anesthesia ◽

Incidence Rate ◽

Urinary Retention ◽

Nasal Surgery ◽

Related Factors ◽

Predisposing Factor ◽

Prostate Hyperplasia ◽

History Of ◽

Male Patients ◽

Endoscopic Nasal Surgery

Abstract Background: Postoperative urinary retention (POUR) after anesthesia and surgery is influenced by many factors, and its reported incidence rate varies widely. The aim of this study was to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged over 60 years. Methods: Retrospective review of medical records between January 2015 and December 2019 identified 253 subjects for inclusion in our study. Age, body mass index, history of diabetes/hypertension, American Society of Anesthesiologists classification, and urologic history were included as patient-related factors. Urologic history was subdivided into three groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following were analyzed as perioperative variables for the development of POUR: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention.Results: Thirty-seven patients (15.7%) had urinary retention requiring catheterization. Among analyzed variables, only urologic history was identified as a predisposing factor. The incidence rate among patients without urologic issues was 5.9%. This compared to 19.8% among patients with a history of BPH/LUTS, which was not reduced by taking medical treatment. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in subjects with POUR. Conclusions: General anesthesia for endoscopic nasal surgery is a potent trigger of urinary retention in male patients aged over 60 years. The urological history of the patient was the most important risk factor, and the occurrence of POUR appears to be affected by urinary conditions. The present study is helpful in understanding the occurrence of POUR following general anesthesia in elderly male patients.

Download Full-text

A Comparative Study of Oral Dexmedetomidine versus Oral Midazolam As preanesthesia Medication in Pediatric Patients to Reduce anxiety

Birat Journal of Health Sciences ◽

10.3126/bjhs.v4i2.25453 ◽

2019 ◽

Vol 4 (2) ◽

pp. 724-728

Author(s):

Sabin Gauchan ◽

Chitra Thapa ◽

Abha Prasai

Keyword(s):

General Anesthesia ◽

Separation Anxiety ◽

Elective Surgery ◽

Sedation Score ◽

Preoperative Anxiety ◽

Parental Separation ◽

Emergence Agitation ◽

Oral Midazolam ◽

Significant Difference ◽

Group D

Introduction: Preoperative period is a stressful period. In children the preoperative anxiety is expressed as difficult separation from parents and difficult mask induction. The level of preoperative anxiety also affects postoperative outcomes. To overcome anxiety premedication is often used by pediatric anesthesiologist. Objective: The objective of this study was to compare the effect of oral midazolam 0.5mg/kg and oral dexmedetomidine 4μg/kg on parental separation, mask induction and postoperative emergence agitation in children undergoing elective surgery under general anesthesia. Methodology: 120 children aged 2-8years undergoing elective surgery under general anesthesia were divided into two groups: Group M and Group D. Patients in group M received oral midazolam 0.5mg/kg and patients in group D received oral dexmedetomidine 4μg/kg. After 45min of premedication sedation score was assessed in both the groups. Ease of parental separation and mask acceptance was compared in both the groups. In the postoperative period occurrence of emergence agitation was compared in both the groups. Results: There was no statistically significant difference in preoperative sedation score in both the groups. Parent separation anxiety score and mask acceptance score were statistically similar in both the groups. But emergence agitation was significantly lesser in patients who received dexmedetomidine premedication. Conclusions: Premedication with oral midazolam as well as oral dexmedetomidine effectively reduces parental separation anxiety and produces satisfactory mask induction in pediatric age group. However, dexmedetomidine is more effective in reducing emergence delirium in comparison to midazolam.

Download Full-text