Risk Factors of Emergence Agitation in Adults Undergoing 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.

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Incidence of Emergence Agitation in Pediatric Patient after General Anesthesia

Folia Medica Indonesiana ◽

10.20473/fmi.v55i1.24340 ◽

2021 ◽

Vol 55 (1) ◽

pp. 25

Author(s):

Lucky Andriyanto ◽

Arie Utariani ◽

Elizeus Hanindito ◽

Kohar Hari Santoso Hari Santoso ◽

Hamzah Hamzah ◽

...

Keyword(s):

Risk Factors ◽

General Anesthesia ◽

Pediatric Patient ◽

Pediatric Anesthesia ◽

Routine Care ◽

Preoperative Anxiety ◽

Emergence Agitation ◽

Spss Software ◽

Associated Risk Factors ◽

Dissociated State

Post anesthesia agitation is common problem in pediatric post anesthesia care unit. The incidences range from 10 to 80%. EA has been described as a dissociated state of consciousness in which the child is inconsolable, irritable, and uncooperative typically thrashing, crying, moaning or incoherent. This study was done to determine the incidence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia. This descriptive and analytic study was performed on 105 pediatric patient aged 1-12 years that underwent general anesthesia for various elective diagnostic and surgeries at Dr. Soetomo Hospital between January and February 2016. The presence of emergence agitation was recorded using Pediatric Anesthesia Emergence Delirium (PAED) scale. The factors that linked with Emergence Agitation were recorded in a questionnaire. The data were analyzed using SPSS software with logistic regression. p - values less than 0.05 were considered as significant. Forty two (40%) children had Emergence Agitation. Preoperative anxiety (p = 0.006) and Pain (p=0.035) were associated with higher rates of post anesthetic emergence agitation. This study identified preoperative anxiety and pain as risk factors, which are associated with emergence agitation in children. To minimize the incidence of post anesthetic emergence agitation, these risk factors should be considered in the routine care by anesthetist.

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Risk factors of emergence agitation after general anesthesia in children; multicenter study

European Journal of Anaesthesiology ◽

10.1097/00003643-201306001-00491 ◽

2013 ◽

Vol 30 ◽

pp. 157-158

Author(s):

C. -J. Chung ◽

S. Choi ◽

S. Park

Keyword(s):

Risk Factors ◽

General Anesthesia ◽

Multicenter Study ◽

Emergence Agitation

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Incidence of Emergence Agitation in Pediatric Patient after General Anesthesia

Folia Medica Indonesiana ◽

10.20473/fmi.v55i1.12546 ◽

2019 ◽

Vol 55 (1) ◽

pp. 25

Author(s):

Lucky Andriyanto ◽

Arie Utariani ◽

Elizeus Hanindito ◽

Kohar Hari Santoso ◽

Hamzah Hamzah ◽

...

Keyword(s):

Risk Factors ◽

General Anesthesia ◽

Pediatric Patient ◽

Pediatric Anesthesia ◽

Routine Care ◽

Preoperative Anxiety ◽

Emergence Agitation ◽

Spss Software ◽

Associated Risk Factors ◽

Dissociated State

Post anesthesia agitation is common problem in pediatric post anesthesia care unit. The incidences range from 10 to 80%. EA has been described as a dissociated state of consciousness in which the child is inconsolable, irritable, and uncooperative typically thrashing, crying, moaning or incoherent. This study was done to determine the incidence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia. This descriptive and analytic study was performed on 105 pediatric patient aged 1-12 years that underwent general anesthesia for various elective diagnostic and surgeries at Dr. Soetomo Hospital between January and February 2016. The presence of emergence agitation was recorded using Pediatric Anesthesia Emergence Delirium (PAED) scale. The factors that linked with Emergence Agitation were recorded in a questionnaire. The data were analyzed using SPSS software with logistic regression. p - values less than 0.05 were considered as significant. Forty two (40%) children had Emergence Agitation. Preoperative anxiety (p = 0.006) and Pain (p=0.035) were associated with higher rates of post anesthetic emergence agitation. This study identified preoperative anxiety and pain as risk factors, which are associated with emergence agitation in children. To minimize the incidence of post anesthetic emergence agitation, these risk factors should be considered in the routine care by anesthetist.

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Risk factors of inadequate emergence following general anesthesia with an emphasis on patients with substance dependence history

Korean Journal of Anesthesiology ◽

10.4097/kja.19214 ◽

2020 ◽

Vol 73 (4) ◽

pp. 302-310 ◽

Cited By ~ 2

Author(s):

Jalil Makarem ◽

Amir Hossein larijani ◽

Babak Eslami ◽

Afshin Jafarzadeh ◽

Kasra Karvandian ◽

...

Keyword(s):

Risk Factors ◽

General Anesthesia ◽

Substance Dependence ◽

Foley Catheter ◽

Adult Patients ◽

Emergence Agitation ◽

Never Married ◽

Neurologic Disorders ◽

Substance Dependent ◽

History Of

Background: This study aims to define the incidence and risk factors of both emergence agitation and hypoactive emergence in adult patients and substance-dependent patients following general anesthesia to elaborate on the risk factors and precise management of them. Methods: The study recruited 1,136 adult patients who received elective surgeries under general anesthesia for this prospective observational study. Inadequate emergence was determined according to the Richmond Agitation-Sedation Scale (RASS). Emergence agitation was defined as a RASS ≥ +1 point, and hypoactive emergence was defined as a RASS ≤ –2 points. Subgroup analyses were then conducted on patients with substance dependence.Results: Inadequate emergence in the post-anesthesia care unit (PACU) occurred in 20.3% of patients, including 13.9% with emergence agitation and 6.4% with hypoactive emergence. Ninety-five patients had a history of substance dependence. Compared to divorced patients, never-married and presently married patients, who underwent gynecological and thoracic surgeries, had a lower risk of agitation. Neurologic disorders, intraoperative blood loss, intraoperative morphine, and PACU analgesic drug administration were associated with increased agitation risk. Hypertension and psychological disorders, intraoperative opioids, and PACU Foley catheter fixation were associated with increased hypoactive emergence risk. Substance-dependent patients had higher risk for agitation (21.1%, P = 0.019) and hypoactive emergence (10.5%, P = 0.044). Conclusions: Inadequate emergence in PACU following general anesthesia is a significant problem correlated with several perioperative factors. Patients with a history of substance dependence appear to be more at risk of inadequate emergence than the general population.

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Risk factors of emergence agitation after general anesthesia in adult patients

Anesthesia and Pain Medicine ◽

10.17085/apm.2016.11.4.410 ◽

2016 ◽

Vol 11 (4) ◽

pp. 410-416 ◽

Cited By ~ 3

Author(s):

Jong Cheol Rim ◽

Jung A Kim ◽

Jeong In Hong ◽

Sang Yoong Park ◽

Jong Hwan Lee ◽

...

Keyword(s):

Risk Factors ◽

General Anesthesia ◽

Adult Patients ◽

Emergence Agitation

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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.

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