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Xu Y, Tung TH, Feng X, Xiang H, Wang Y, Wu H. The effect of magnesium sulfate on emergence agitation in surgical adult patients undergoing general anesthesia: A systematic review and meta-analysis of randomized controlled trials. J Clin Anesth 2024; 96:111499. [PMID: 38749290 DOI: 10.1016/j.jclinane.2024.111499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/31/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024]
Abstract
STUDY OBJECTIVE Investigating the effect of magnesium sulfate (MS) on emergence agitation (EA) in adult surgical patients following general anesthesia (GA). DESIGN Systematic literature review and meta-analysis (PROSPERO number: CRD42023461988). SETTING Review of published literature. PATIENTS Adults undergoing GA. INTERVENTIONS Intravenous administration of MS. MEASUREMENTS We searched PubMed/MEDLINE, EMBASE, the Cochrane Library, Scopus, and Web of Science for publications until September 14, 2023. The primary outcome was the incidence of EA, while the secondary outcomes included the impact of MS on postoperative agitation score (PAS), emergence variables and adverse events. Relative risk (RR) with 95% confidence interval (CI) measured dichotomous outcome, while standardized mean difference (SMD) or mean difference (MD) with 95% CI measured continuous outcomes. MAIN RESULTS Meta-analysis of five randomized controlled trials (RCTs) indicated that MS was associated with a lower incidence of EA at various time points (0 min: RR = 0.62, 95% CI [0.41, 0.95]; p = 0.183, I2 = 43.6%; 5 min: RR = 0.29, 95% CI [0.16, 0.52]; p = 0.211, I2 = 36%; 10 min: RR = 0.14, 95% CI [0.06, 0.32]; p = 0.449, I2 = 0%; 15 min: RR = 0.11, 95% CI [0.02, 0.55]; p = 0.265, I2 = 19.5%; 30 min: RR = 0.05, 95% CI [0.00, 0.91]; the postoperative period: RR = 0.21, 95% CI [0.09, 0.49]; p = 0.724, I2 = 0%;). Additionally, MS was associated with a reduced PAS at various time points except for 0 min. However, no significant differences were observed in extubation time, the length of stay in the post-anesthesia care unit, postoperative nausea and vomiting or total complications. CONCLUSIONS Limited available evidence suggests that MS was associated with a lower incidence of EA. Nevertheless, further high-quality studies are warranted to strengthen and validate the effect of MS in preventing EA in adult surgical patients.
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Affiliation(s)
- Ying Xu
- Evidence-based Medicine Centre, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China; Institute for Hospital Management, Tsinghua University, Beijing 100084, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Centre, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Xiaoru Feng
- Institute for Hospital Management, Tsinghua University, Beijing 100084, China; School of Medicine, Tsinghua University, Beijing 100084, China
| | - Haifei Xiang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Yu Wang
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Hao Wu
- Department of Anesthesiology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China.
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Cho SA, Ahn SM, Kwon W, Sung TY. Comparison of remimazolam and desflurane in emergence agitation after general anesthesia for nasal surgery: a prospective randomized controlled study. Korean J Anesthesiol 2024; 77:432-440. [PMID: 38711267 PMCID: PMC11294877 DOI: 10.4097/kja.23953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/31/2024] [Accepted: 04/14/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Remimazolam is an ultrashort-acting benzodiazepine. Few studies have evaluated the effects of remimazolam-based total intravenous anesthesia (TIVA) on emergence agitation (EA). This study aimed to compare the incidence and severity of EA between TIVA using remimazolam and desflurane. METHODS This prospective randomized controlled study enrolled 76 patients who underwent nasal surgery under general anesthesia. Patients were randomized into two groups of 38 each: desflurane-nitrous oxide (N2O) (DN) and remimazolam-remifentanil (RR) groups. The same protocol was used for each group from induction to emergence, except for the use of different anesthetics during maintenance of anesthesia according to the assigned group: desflurane and nitrous oxide for the DN group and remimazolam and remifentanil for the RR group. The incidence of EA as the primary outcome was evaluated using three scales: Ricker Sedation-Agitation Scale, Richmond Agitation-Sedation Scale, and Aono's four-point agitation scale. Additionally, hemodynamic changes during emergence and postoperative sense of suffocation were compared. RESULTS The incidence of EA was significantly lower in the RR group than in the DN group in all three types of EA assessment scales (all P < 0.001). During emergence, the change in heart rate differed between the two groups (P = 0.002). The sense of suffocation was lower in the RR group than in the DN group (P = 0.027). CONCLUSIONS RR reduced the incidence and severity of EA in patients undergoing nasal surgery under general anesthesia. In addition, RR was favorable for managing hemodynamics and postoperative sense of suffocation.
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Affiliation(s)
- Sung-Ae Cho
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
- Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - So-min Ahn
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Woojin Kwon
- 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
- Myunggok Medical Research Center, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
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Landoni G, Likhvantsev VV, Berikashvili LB, Yavorovsky AG, Bagdasarov PS, Smirnova AV, Serkova TS, Subbotin VV, Kadantseva KK, Ovezov AM, Yadgarov MY, Yakovlev AA, Lamacchia A, Gallo L, Gracheva ND, Ryzhkov PV, Zilocchi R, Vecchi JD, Aleinikov MA, Mayuk PS, Pivovarova AA, Shemetova MM. Sevoflurane multiple Wash In/Wash Out at the end of anesthesia to reduce agitation: A multicenter double-blind randomized controlled trial. Contemp Clin Trials Commun 2024; 39:101316. [PMID: 38881542 PMCID: PMC11176941 DOI: 10.1016/j.conctc.2024.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Background Postoperative agitation is common after non-cardiac surgery. It is associated with postoperative delirium and cognitive dysfunction, leading to prolonged hospital stay and delayed social readjustment. Prevention and treatment strategies are lacking. We assessed the efficacy of a novel approach, the Wash In/Wash Out procedure, in reducing post-anesthetic agitation. Methods This multicenter, parallel-group, double-blind randomized controlled trial is enrolling 200 patients undergoing open abdominal surgery. Participants are randomly assigned to either a control group receiving standard recovery methods or an investigational group undergoing the Wash In/Wash Out procedure. In the Wash In/Wash Out procedure group, sevoflurane is stopped and then promptly restarted when the patient shows the first signs of awakening to achieve an end-tidal concentration of 1 minimum alveolar concentration (MAC) for 5 min. This stop-and-restart cycle is performed three times. The trial's primary outcome is the rate of postoperative agitation. Secondary outcomes include rate of postoperative delirium and cognitive dysfunction, postoperative nausea and vomiting, and length of intensive care and hospital stay. Discussion The OPERA trial investigates the effect of the Wash In/Wash Out procedure to reduce post-anesthetic agitation in non-cardiac surgery. This study could offer a significant contribution to improving patient outcomes and optimizing recovery protocols in surgical settings.
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Affiliation(s)
- Giovanni Landoni
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Valery V Likhvantsev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
- First University Clinical Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Levan B Berikashvili
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Andrey G Yavorovsky
- First University Clinical Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Pavel S Bagdasarov
- First University Clinical Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Anastasia V Smirnova
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Tatiana S Serkova
- First University Clinical Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | | | - Kristina K Kadantseva
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
- A. Loginov Moscow Scientific Clinical Center, Moscow, Russia
| | - Alexey M Ovezov
- M. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - Mikhail Ya Yadgarov
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Alexey A Yakovlev
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Andrea Lamacchia
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Italy
| | - Lorenzo Gallo
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Italy
| | - Nadezhda D Gracheva
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Pavel V Ryzhkov
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
| | - Rachele Zilocchi
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Italy
| | - Jessica De Vecchi
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Italy
| | - Maksim A Aleinikov
- First University Clinical Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Pavel S Mayuk
- First University Clinical Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Alina A Pivovarova
- M. Vladimirsky Moscow Regional Research and Clinical Institute, Moscow, Russia
| | - Maria M Shemetova
- Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia
- Moscow City Oncological Hospital No.1, Moscow, Russia
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Jones H, Robson K, Maddox T, Alderson B. Incidence of and risk factors for poor recovery quality in dogs recovering from general anaesthesia-a prospective case control study. Vet Anaesth Analg 2024; 51:227-234. [PMID: 38350794 DOI: 10.1016/j.vaa.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To investigate the incidence of and identify risk factors associated with poor quality of recovery in dogs recovering from general anaesthesia. STUDY DESIGN Case controlled study. METHODS All dogs undergoing general anaesthesia at the University of Liverpool Small Animal Teaching Hospital between January 2020 and January 2021 were eligible for recruitment. Signalment, anaesthetic case management and a recovery score were recorded. Univariable and multivariable logistic and ordinal logistic regression analysis were used to identify factors which impact incidence of poor quality of recovery. RESULTS A total of 247 dogs undergoing general anaesthesia were included. Overall, 72 [29.1%; 95% confidence interval (CI) 23.8%-35.1%] dogs experienced a poor quality recovery. Of these, 40 (55.5%) required sedation to manage behaviours associated with poor recovery. Multivariable logistic regression revealed American Society of Anesthesiologists (ASA) physical status classification of III or higher was associated with a decreased incidence of poor quality recovery [odds ratio (OR) = 0.34, 95% CI 0.12-0.93, p = 0.037] and the use of multiple inhalational anaesthetics during one procedure was associated with an increased incidence of poor quality of recovery (OR = 42.5, 95% CI 3.0-598.3, p = 0.005). CONCLUSIONS AND CLINICAL RELEVANCE Poor quality recovery is common in dogs recovering from general anaesthesia and sedation is often required for resolution. It is more likely to occur in healthy veterinary patients (ASA I and II). The use of multiple inhalational anaesthetic agents during one procedure should be discouraged as this may increase the likelihood of poor quality of recovery.
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Affiliation(s)
- Heather Jones
- Department of Small Animal Clinical Science, University of Liverpool, Neston, UK.
| | - Katherine Robson
- Department of Small Animal Clinical Science, University of Liverpool, Neston, UK
| | - Thomas Maddox
- Department of Small Animal Clinical Science, University of Liverpool, Neston, UK
| | - Briony Alderson
- Department of Small Animal Clinical Science, University of Liverpool, Neston, UK
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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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Effect of ketamine on emergence agitation following septoplasty: a randomized clinical trial. Braz J Anesthesiol 2021; 71:381-386. [PMID: 33762196 PMCID: PMC9373669 DOI: 10.1016/j.bjane.2020.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/29/2020] [Accepted: 12/12/2020] [Indexed: 11/22/2022] Open
Abstract
Background and objectives The risk of emergence agitation (EA) is high in patients undergoing nasal surgery. The aim of the present study was to investigate the incidence of EA in adults undergoing septoplasty and the effect of ketamine on EA. Methods In this randomized study, a total of 102 ASA I–II patients who underwent septoplasty between July 2018 and April 2019 were divided into two groups: ketamine (Group-K, n = 52) and saline (Group-S, n = 50). After anesthesia induction, Group-K was intravenously administered 20 mL of saline containing 1 mg kg−1 ketamine, whereas Group-S was administered 20 mL of saline. Sedation and agitation scores at emergence from anesthesia, incidence of cough, emergence time, and response to verbal stimuli time were recorded. The sedation/agitation and pain levels were recorded for 30 minutes in the recovery unit. Results There was no significant difference between the groups in terms of the incidence of EA (Group-K: 15.4%, Group-S: 24%). The incidence of cough during emergence was higher in Group-S than in Group-K, but the response time to verbal stimuli and emergence time were shorter in Group-S. The sedation and agitation scores were similar after surgery. Pain scores were higher in Group-S at the time of admission to the recovery unit and were similar between groups in the other time points. Conclusion Administration of 1 mg kg−1 ketamine after anesthesia induction does not affect the incidence of EA in patients undergoing septoplasty, but it prolongs the emergence and response time to verbal stimuli and reduces the incidence of cough.
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Comparison of Rhinoplasty Patients Informed With Standard Verbal Information in Preoperative Period and Rhinoplasty Patients Informed and Treated With Visual Information Through Catalog in Terms of the Development of Agitation, Edema and Ecchymose in the Postoperative Period. J Craniofac Surg 2020; 31:816-820. [PMID: 32049912 DOI: 10.1097/scs.0000000000006206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
AIM In this study, we aimed to compare the effects of standard verbal information in the preoperative period and the information by visual expression and physical applications in the development of agitation, edema and ecchymosis in the postoperative period. MATERIALS AND METHODS The study was carried out in 60 ASA I-II patients who were going to undergo open rhinoplasty by plastic surgery. In the Preoperative Anesthetic Assessment the patients were divided into two groups as the patients given standard verbal information (Group S; n = 30) and those informed with a catalog which contains visuals (Group V; n = 30) In the preoperative period, anxiety levels of the patients were evaluated. Standard anesthesia induction was performed in both groups after standard monitoring. Patients were monitored in the post-anesthesia care unit and ward. Patient's extubation quality, presence of postoperative agitation and periorbital edema and ecchymosis at the 6th, 12th, 18th, and 24th hours were evaluated. RESULTS No significant difference was found between the groups in terms of intraoperative and postoperative MAP, HR, extubation quality, presence of recovery agitation, postoperative pain, development edema and ecchymosis (P > 0.05). Significant positive correlation was found between post-extubation MAP and edema scores at the 16th and 24th hours postoperatively and between the post-anesthesia care unit entry MAP and ecchymosis at the 24th postoperative hours independently of the groups (r = 0.27; P = 0.038, r = 0.302; P = 0.019, r = 0.345; P = 0.007, respectively). RESULT In our study, it was concluded that detailed visual information and physical application in the preoperative period among rhinoplasty patients had no effect on the incidence of postoperative agitation, development of edema and ecchymosis.
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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: 58] [Impact Index Per Article: 14.5] [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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Elaziz RAEA, Shaban S, Elaziz SA. Effects of Lidocaine Infusion on Quality of Recovery and Agitation after Functional Endoscopic Sinus Surgery: Randomized Controlled Study. OPEN JOURNAL OF ANESTHESIOLOGY 2020; 10:435-448. [DOI: 10.4236/ojanes.2020.1012038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Lee SJ, Sung TY, Cho CK. Comparison of emergence agitation between succinylcholine and rocuronium-sugammadex in adults following closed reduction of a nasal bone fracture: a prospective randomized controlled trial. BMC Anesthesiol 2019; 19:228. [PMID: 31842841 PMCID: PMC6916043 DOI: 10.1186/s12871-019-0907-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/08/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Sugammadex 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. METHODS Forty-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. RESULTS The 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). CONCLUSION Succinylcholine increases the incidence, severity, and duration of EA compared to rocuronium-sugammadex in patients undergoing closed reduction of a nasal bone fracture. TRIAL REGISTRATION CRiS Registration number KCT0002673. Initial registration date was 31 January 2018 (Retrospectively registered).
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Affiliation(s)
- Seok-Jin Lee
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, 158, Gwangeodong-ro, Seo-gu, Daejeon, 35365, South Korea
| | - Tae-Yun Sung
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, 158, Gwangeodong-ro, Seo-gu, Daejeon, 35365, South Korea.
| | - Choon-Kyu Cho
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, 158, Gwangeodong-ro, Seo-gu, Daejeon, 35365, South Korea
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Lee SJ, Choi SJ, In CB, Sung TY. Effects of tramadol on emergence agitation after general anesthesia for nasal surgery: A retrospective cohort study. Medicine (Baltimore) 2019; 98:e14763. [PMID: 30855478 PMCID: PMC6417523 DOI: 10.1097/md.0000000000014763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Emergence agitation (EA) is common after nasal surgery. Strong opioids and N-methyl-D-aspartate (NMDA) receptor antagonists prevent EA. Tramadol also acts as an opioid receptor agonist and an NMDA receptor antagonist, but few studies have evaluated the effects of tramadol on EA. This retrospective study investigated whether tramadol is effective for reducing EA in adult patients undergoing nasal surgery.Of 210 adult patients undergoing a nasal surgical procedure under general anesthesia, the medical records of 113 were analyzed retrospectively. The patients were divided into 2 groups: patients who received tramadol during the operation (tramadol group, n = 52) and patients who did not (control group, n = 61). The incidence of EA, recovery time, changes in hemodynamic parameters, postoperative pain scores, and adverse events were compared between the 2 groups.The incidence of EA was higher in the control group than in the tramadol group (50.8% [31/61] vs 26.9% [14/52]; odds ratio 2.805; 95% confidence interval, 1.3 to 6.2; P = .010). Changes in systolic blood pressure in the 2 groups were similar, whereas changes in heart rate during emergence differed depending on the group (P = .020), although pairwise comparisons did not reveal any differences between the groups. Recovery time, postoperative pain scores, and adverse events were similar in the 2 groups.In adult patients undergoing nasal surgery, tramadol infusion decreases the incidence of EA after sevoflurane anesthesia without delaying recovery or increasing the number of adverse events.
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Affiliation(s)
- Seok-Jin Lee
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital
| | - Seok Jun Choi
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital
| | - Chi Bum In
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital
| | - Tae-Yun Sung
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
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