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Kotake K, Matsunuma S, Kitamura N, Noritake Y, Kawakami Y. Preventive effects of first-generation antihistamine on emergence agitation or delirium: a systematic review. Eur J Clin Pharmacol 2024:10.1007/s00228-024-03748-9. [PMID: 39264446 DOI: 10.1007/s00228-024-03748-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 08/26/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE The effects of first-generation antihistamines in preventing postoperative emergence agitation or delirium are unclear. Determining the postoperative effects of first-generation antihistamines may provide important insights into the management of patient safety. Therefore, we performed a systematic review of randomized controlled trials (RCTs) evaluating the efficacy and safety of postoperative first-generation antihistamines. METHODS Patients who used first-generation antihistamines in the intensive care unit or operating room were included. Primary outcomes were assessed postoperative emergence agitation or delirium with binary and continuous variables. The secondary outcome was any adverse event. RESULTS Nine studies were included. The frequency of postoperative emergence agitation, measured using binary variables, tended to be lower in patients receiving chlorpheniramine or diphenhydramine than those receiving saline. However, evaluation using the Richmond Agitation-Sedation Scale as a continuous variable revealed that only chlorpheniramine was effective at lowering postoperative emergence agitation. Only one study assessed delirium but found no benefit of first-generation antihistamines. Adverse events for first-generation antihistamines did not differ from that of other drugs. CONCLUSION Our results provide limited evidence that some first-generation antihistamines may prevent postoperative emergence agitation and are safe. To further verify this possibility, new RCTs with clear and universal assessment criteria for postoperative emergence agitation or delirium should be conducted.
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Affiliation(s)
- Kazumasa Kotake
- Department of Pharmacy, Zikei Hospital, Zikei Institute of Psychiatry, 100-2 Urayasu Honmachi, Minami-Ku, Okayama-shi, Okayama, 702-8508, Japan.
| | - Satoru Matsunuma
- Department of Pharmacy, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0988, Japan
| | - Naoya Kitamura
- Department of Neuropsychiatry, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-ku, Okayama-shi, Okayama, 700-8511, Japan
| | - Yumi Noritake
- Department of Pharmacy, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-ku, Okayama-shi, Okayama, 700-8511, Japan
| | - Yasuhiro Kawakami
- Department of Pharmacy, Okayama Saiseikai General Hospital, 2-25 Kokutaicho, Kita-ku, Okayama-shi, Okayama, 700-8511, Japan
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Guo N, Cao J, Duan M, Zhou F, Wang W, Xu L, Wei C, Song X. Effects of ciprofol infusion on hemodynamics during induction and maintenance of anesthesia and on postoperative recovery in patients undergoing thoracoscopic lobectomy: Study protocol for a randomized, controlled trial. PLoS One 2024; 19:e0305478. [PMID: 38985796 PMCID: PMC11236111 DOI: 10.1371/journal.pone.0305478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
INTRODUCTION Ciprofol, a new candidate drug, is effective and safe for the maintenance of anesthesia in non-cardiothoracic and non-neurological elective surgery. However, few studies have been conducted on general anesthesia using ciprofol in patients undergoing thoracoscopic lobectomy. Therefore, this study aims to observe the effects of ciprofol on hemodynamics and on postoperative recovery in patients undergoing thoracoscopic lobectomy. METHODS AND ANALYSIS This randomized controlled trial will include 136 patients aged 18-65 years undergoing elective thoracoscopic lobectomy between April 2023 and December 2024. The participants will be randomly assigned to the propofol or ciprofol group. The primary outcome to be assessed is the hemodynamic fluctuation during the induction and maintenance of anesthesia. The secondary outcomes involve quality of anesthesia induction and quality of recovery from anesthesia. The former includes TLOC (time to loss of consciousness), the use of vasoactive agents, the incidence of injection pain, body movement, muscle twitching and coughing during induction of anesthesia. The latter includes TROC (time to recovery of consciousness), post anesthesia care unit (PACU) time, incidence of postoperative nausea and vomiting (PONV), postoperative agitation, intraoperative awareness and quality of recovery (QoR) score. DISCUSSION A number of clinical trials have confirmed that ciprofol, as a new sedative-hypnotic agent, has advantages of better tolerance, higher sedation satisfaction score, and lower incidence of adverse reactions, especially in reducing the incidence of injection pain. But considering that ciprofol was recently developed, limited data are available regarding its use for general anesthesia. This study aims to investigate the effects of ciprofol on hemodynamics and on postoperative recovery of patients undergoing thoracoscopic lobectomy. The results of this study may provide evidence for the safe application of ciprofol, a new choice of general anesthetic for thoracic surgery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT05664386).
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Affiliation(s)
- Na Guo
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji’nan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Ji’nan, China
- Shandong Provincial Clinical Research Center for Anesthesiology, Ji’nan, China
| | - Jianqiao Cao
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji’nan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Ji’nan, China
- Shandong Provincial Clinical Research Center for Anesthesiology, Ji’nan, China
| | - Mingjie Duan
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji’nan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Ji’nan, China
- Shandong Provincial Clinical Research Center for Anesthesiology, Ji’nan, China
| | - Fei Zhou
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji’nan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Ji’nan, China
- Shandong Provincial Clinical Research Center for Anesthesiology, Ji’nan, China
| | - Wei Wang
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji’nan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Ji’nan, China
- Shandong Provincial Clinical Research Center for Anesthesiology, Ji’nan, China
| | - Lingling Xu
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji’nan, China
| | - Chuansong Wei
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji’nan, China
| | - Xiumei Song
- Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Ji’nan, China
- Shandong Institute of Anesthesia and Respiratory Critical Medicine, Ji’nan, China
- Shandong Provincial Clinical Research Center for Anesthesiology, Ji’nan, China
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Wang N, Hao J, Zhang J, Du J, Luo Z. Risk factors for emergence agitation during the awakening period in elderly patients after total joint arthroplasty: a retrospective cohort study. BMJ Open 2023; 13:e068284. [PMID: 37164475 PMCID: PMC10174031 DOI: 10.1136/bmjopen-2022-068284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES This study aimed to explore the incidence and risk factors for emergence agitation (EA) in elderly patients who underwent total joint arthroplasty (TJA) under general anaesthesia, and to assess their predictive values. DESIGN Single-centre retrospective cohort study. SETTING A 1600-bed general tertiary hospital in China. PARTICIPANTS This study enrolled 421 elderly patients scheduled for elective primary TJA under general anaesthesia. PRIMARY AND SECONDARY OUTCOME MEASURES EA was assessed using the Richmond Agitation Sedation Scale during the awakening period after surgery in the post-anaesthesia care unit. Risk factors for EA were identified using univariate and multivariable logistic analyses. The receiver operating characteristic (ROC) curve was used to assess the predictive values of the risk factors for EA. RESULTS The incidence of EA in elderly patients who underwent TJA was 37.6%. According to the multivariable logistic analysis, postoperative pain (95% CI: 1.951 to 3.196), male sex (95% CI: 1.781 to 6.435), catheter-related bladder discomfort (CRBD) (95% CI: 4.001 to 15.392) and longer fasting times for solids (95% CI: 1.260 to 2.301) and fluids (95% CI: 1.263 to 2.365) were independent risk factors for EA. As shown by the ROC analysis, postoperative pain and fasting times for solids and fluids had good predictive values, with areas under the ROC curve equalling 0.769, 0.753 and 0.768, respectively. CONCLUSIONS EA is a common complication after TJA in elderly patients. Some risk factors, including postoperative pain, male sex, CRBD and longer fasting times, can increase the incidence of EA. These risk factors may contribute to identifying high-risk patients, which facilitates the development of effective strategies to prevent and treat EA. TRIAL REGISTRATION NUMBER ChiCTR1800020193.
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Affiliation(s)
- Naigeng Wang
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jianhong Hao
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jie Zhang
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jing Du
- Second Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Zhenguo Luo
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Wang Q, Zhou J, Liu T, Yang N, Mi X, Han D, Han Y, Chen L, Liu K, Zheng H, Zhang J, Lin X, Li Y, Hong J, Li Z, Guo X. Predictive Value of Preoperative Profiling of Serum Metabolites for Emergence Agitation After General Anesthesia in Adult Patients. Front Mol Biosci 2021; 8:739227. [PMID: 34746231 PMCID: PMC8566542 DOI: 10.3389/fmolb.2021.739227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/20/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Emergence agitation (EA) in adult patients under general anesthesia leads to increased postoperative complications and heavy medical burden. Unfortunately, its pathogenesis has not been clarified until now. The purpose of the present study was to explore the relationship between preoperative serum metabolites and EA. Methods: We used an untargeted metabolic analysis method to investigate the different metabolomes in the serum of EA patients and non-EA patients undergoing elective surgical procedures after the induction of general anesthesia. A Richmond Agitation-Sedation Scale score ≥ +2 was diagnosed as EA during postoperative emergence. Non-EA patients were matched with EA patients according to general characteristics. Preoperative serum samples of the two groups were collected to investigate the association between serum metabolites and EA development. Results: The serum samples of 16 EA patients with 34 matched non-EA patients were obtained for metabolic analysis. After screening and alignment with databases, 31 altered metabolites were detected between the two groups. These metabolites were mainly involved in the metabolism of lipids, purines, and amino acids. Analyses of receiver-operating characteristic curves showed that the preoperative alterations of choline, cytidine, glycerophosphocholine, L-phenylalanine, oleamide, and inosine may be associated with adult EA. Conclusion: Multiple metabolic abnormalities (including those for lipids, purines, and amino acids) and other pathological processes (e.g., neurotransmitter imbalance and oxidative stress) may contribute to EA. Several altered metabolites in serum before surgery may have predictive value for EA diagnosis. This study might afford new metabolic clues for the understanding of EA pathogenesis.
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Affiliation(s)
- Qian Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jiansuo Zhou
- Department of Laboratory Medicine, Peking University Third Hospital, Beijing, China
| | - Taotao Liu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Ning Yang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xinning Mi
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Dengyang Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yongzheng Han
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Lei Chen
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Kaixi Liu
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Hongcai Zheng
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jing Zhang
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xiaona Lin
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Yitong Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jingshu Hong
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Zhengqian Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Xiangyang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
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Méndez-Martínez C, Fernández-Martínez MN, García-Suárez M, Martínez-Isasi S, Fernández-Fernández JA, Fernández-García D. Related Factors and Treatment of Postoperative Delirium in Old Adult Patients: An Integrative Review. Healthcare (Basel) 2021; 9:healthcare9091103. [PMID: 34574877 PMCID: PMC8470646 DOI: 10.3390/healthcare9091103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 11/28/2022] Open
Abstract
“Postoperative delirium” is defined as delirium occurring in the hospital up to one week after a procedure or before discharge (whichever occurs first) that meets the DSM-5 diagnostic criteria. Objectives: To describe the risk factors related to this pathology and identify effective non-pharmacological forms of treatment. An integrative review of the available literature was performed. The search results considered included all quantitative studies published between 2011 and 2019 in both English and Spanish. A total of 117 studies were selected. Advanced age was identified as the principal risk factor for postoperative delirium. Nursing interventions appear to be the key to preventing or reducing the seriousness of delirium after an anaesthetic episode. The aetiology of postoperative delirium remains unknown, and no treatment exists to eliminate this pathology. The role of nursing staff is fundamental in the prevention, diagnosis, and management of the pathology.
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Affiliation(s)
- Carlos Méndez-Martínez
- Department of Nursing and Physiotherapy, University of León, 24071 León, Spain; (M.G.-S.); (J.A.F.-F.); (D.F.-G.)
- University Hospital of León, 24071 León, Spain
- Correspondence:
| | - María Nélida Fernández-Martínez
- Department of Biomedical Sciences, Institute of Biomedicine (IBIOMED), Veterinary Faculty, University of Leon, 24071 Leon, Spain;
| | - Mario García-Suárez
- Department of Nursing and Physiotherapy, University of León, 24071 León, Spain; (M.G.-S.); (J.A.F.-F.); (D.F.-G.)
- University Hospital of León, 24071 León, Spain
| | - Santiago Martínez-Isasi
- CLINURSID Research Group, Psychiatry, Radiology, Public Health, Nursing and Medicine Department, Universidade de Santiago de Compostela, 15705 Santiago de Compostela, Spain;
- Simulation and Intensive Care Unit of Santiago (SICRUS) Research Group, Health Research Institute of Santiago, University Hospital of Santiago de Compostela CHUS, 15706 Santiago de Compostela, Spain
| | - Jesús Antonio Fernández-Fernández
- Department of Nursing and Physiotherapy, University of León, 24071 León, Spain; (M.G.-S.); (J.A.F.-F.); (D.F.-G.)
- University Hospital of León, 24071 León, Spain
| | - Daniel Fernández-García
- Department of Nursing and Physiotherapy, University of León, 24071 León, Spain; (M.G.-S.); (J.A.F.-F.); (D.F.-G.)
- University Hospital of León, 24071 León, Spain
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Tolly B, Waly A, Peterson G, Erbes CR, Prielipp RC, Apostolidou I. Adult Emergence Agitation: A Veteran-Focused Narrative Review. Anesth Analg 2021; 132:353-364. [PMID: 33177329 DOI: 10.1213/ane.0000000000005211] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
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.
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Affiliation(s)
- Brian Tolly
- From the Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,Department of Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Amr Waly
- From the Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Garrett Peterson
- From the Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota
| | - Christopher R Erbes
- From the Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,Department of Psychiatry, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Richard C Prielipp
- Department of Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota
| | - Ioanna Apostolidou
- From the Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.,Department of Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota
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The relationship between DNA methylation in neurotrophic genes and age as evidenced from three independent cohorts: differences by delirium status. Neurobiol Aging 2020; 94:227-235. [PMID: 32650186 DOI: 10.1016/j.neurobiolaging.2020.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/07/2020] [Accepted: 06/06/2020] [Indexed: 12/19/2022]
Abstract
We previously reported the association between DNA methylation (DNAm) of pro-inflammatory cytokine genes and age. In addition, neurotrophic factors are known to be associated with age and neurocognitive disorders. Therefore, we hypothesized that DNAm of neurotrophic genes change with age, especially in delirium patients. DNAm was analyzed using the Illumina HumanMethylation450 or HumanMethylationEPIC BeadChip Kit in 3 independent cohorts: blood from 383 Grady Trauma Project subjects, brain from 21 neurosurgery patients, and blood from 87 inpatients with and without delirium. Both blood and brain samples showed that most of the DNAm of neurotrophic genes were positively correlated with age. Furthermore, DNAm of neurotrophic genes was more positively correlated with age in delirium cases than in non-delirium controls. These findings support our hypothesis that the neurotrophic genes may be epigenetically modulated with age, and this process may be contributing to the pathophysiology of delirium.
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Lee SJ, Sung TY. Emergence agitation: current knowledge and unresolved questions. Korean J Anesthesiol 2020; 73:471-485. [PMID: 32209961 PMCID: PMC7714637 DOI: 10.4097/kja.20097] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/23/2020] [Indexed: 12/21/2022] Open
Abstract
Emergence agitation (EA), also referred to as emergence delirium, can have clinically significant consequences. The mechanism of EA remains unclear. The proposed risk factors of EA include age, male sex, type of surgery, emergency operation, use of inhalational anesthetics with low blood-gas partition coefficients, long duration of surgery, anticholinergics, premedication with benzodiazepines, voiding urgency, postoperative pain, and the presence of invasive devices. If preoperative or intraoperative objective monitoring could predict the occurrence of agitation during emergence, this would help to reduce its adverse consequences. Several tools are available for assessing EA. However, there are no standardized clinical research practice guidelines and its incidence varies considerably with the assessment tool or definition used. Total intravenous anesthesia, propofol, μ-opioid agonists, N-methyl-D-aspartate receptor antagonists, nefopam, α2-adrenoreceptor agonists, regional analgesia, multimodal analgesia, parent-present induction, and preoperative education for surgery may help in preventing of EA. However, it is difficult to identify patients at high risk and apply preventive measures in various clinical situations. The risk factors and outcomes of preventive strategies vary with the methodologies of studies and patients assessed.This review discusses important outcomes of research on EA and directions for future research.
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Affiliation(s)
- Seok-Jin Lee
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Xu H, Mei XP, Xu LX. Cause analysis, prevention, and treatment of postoperative restlessness after general anesthesia in children with cleft palate. J Dent Anesth Pain Med 2017; 17:13-20. [PMID: 28879324 PMCID: PMC5564132 DOI: 10.17245/jdapm.2017.17.1.13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/08/2017] [Accepted: 03/13/2017] [Indexed: 11/15/2022] Open
Abstract
Cleft palate is one of the most common congenital malformations of the oral and maxillofacial region, with an incidence rate of around 0.1%. Early surgical repair is the only method for treatment of a cleft lip and palate. However, because of the use of inhalation anesthesia in children and the physiological characteristics of the cleft palate itself combined with the particularities of cleft palate surgery, the incidence rate of postoperative emergence agitation (EA) in cleft palate surgery is significantly higher than in other types of interventions. The exact mechanism of EA is still unclear. Although restlessness after general anesthesia in children with cleft palate is self-limiting, its effects should be considered by clinicians. In this paper, the related literature on restlessness after surgery involving general anesthesia in recent years is summarized. This paper focuses on induction factors as well as prevention and treatment of postoperative restlessness in children with cleft palate after general anesthesia. The corresponding countermeasures to guide clinical practice are also presented in this paper.
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Affiliation(s)
- Hao Xu
- Institution of Basic Medical Science, Xi'an Medical University, Xi'an, China
| | - Xiao-Peng Mei
- Department of Anesthesiology, the First Affiliated Hospital of Xi'an JiaoTong University, Xi'an China
| | - Li-Xian Xu
- Department of Anesthesiology, School of Stomatology, the Fourth Military Medical University, Xi'an, China
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