Comparative study of emergence agitation between isoflurane and propofol anesthesia in adults after closed reduction of distal radius fracture

Abstract

ABSTRACT. Distal radius fracture is a common wound. It is reduced by surgery under anesthesia. Emergence agitation can often occur after anesthesia. It is associated with increased morbidity and hospital costs. However, there have been almost no reports in the medical literature on the occurrence of emergence agitation in adults. This study aimed to compare emergence agitation between isoflurane and propofol anesthesia in adults after closed reduction of distal radius fracture. Forty adults (ASA I-II) undergoing closed reduction of distal radius fracture were randomly assigned to either the isoflurane or propofol group and anesthesia was maintained with isoflurane or propofol. The bispectral index was monitored and maintained within 40-60. After reduction of fracture and fixation with plaster, patients were transported to the post-anesthetic care unit (PACU) and agitation state scale was checked by Aono's four-point scale (AFPS). AFPS score of 3 or 4 was considered to be emergence agitation. Pain scores were measured by the numeric rating scale (NRS) on arrival and at peak value at PACU. Eight (40.0%) patients in the isoflurane group and 2 (10.0%) patients in the propofol group developed emergence agitation (P = 0.031). There was no correlation between peak NRS and AFPS. Propofol may decrease the incidence of emergence agitation compared to isoflurane in adults undergoing closed reduction of distal radius fracture.

Inhalational Versus Propofol-based Intravenous Maintenance of Anesthesia for Emergence Delirium in Adults: A Meta-analysis and Trial Sequential Analysis

“…Finally, 12 RCTs including 1440 patients were included in the metaanalysis. [17][18][19][20][21][22][23][24][25][26][27][28] The characteristics and interventions of the included studies are summarized in Table 1.…”

“…Due to the characteristic of the intervention, blinding of the anesthesiologist was impossible, but blinding of outcomes was reported in 9 of the RCTs. [18][19][20][21][22][23][24][25]27 Thus, these 9 studies [18][19][20][21][22][23][24][25]27 were regarded as having a low risk of bias, and the remaining 3 studies 17,26,28 were considered to have a moderate risk of bias. The nearly symmetrical funnel plot indicated that a low risk of publication bias existed among the included studies (Fig.…”

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

“…Propofol also reduces the hangover effect and provides an antiemetic effect that may be linked to the lower incidence of EA. [ 5 6 12 ]…”

Pain Perception following Initial Closed Reduction in the Preoperative Care of Unstable, Dorsally Displaced Distal Radius Fractures

“…They reported the new method as significantly more painful than the conventional technique with anesthesia (5.2 vs. 3.4), with no patient having interrupted the reduction process because of intolerable pain. Liu et al 9 compared isoflurane and propofol for general anesthesia during reduction with respect to the occurrence of emergence agitation as well as the peak pain score at arrival at postanesthetic care unit. They reported no statistical difference between the two groups for pain scores (4.1 vs. 4.7) or for the occurrence of emergence agitation.…”

“…6 However, closed reduction is accompanied by significant pain, which necessitates the application of intravenous analgesics or even hematoma blocks. [7][8][9][10] This is thereby accepted in the light of an expected relief of pain and discomfort during plaster immobilization. While pain perception during initial reduction has been extensively reported in the literature, the time period from initial treatment to surgery is not addressed yet.…”