Factors Affecting Postoperative Agitation in Adults Following Functional Endoscopic Sinus Surgery: A Randomized, Double - Blinded Controlled Trial

Abstract

Background: We have noticed a high incidence of postoperative agitation (POA) following functional endoscopic sinus surgery (FESS), we reviewed our anesthesia protocol and designed this study. The present study investigated the possible contributing factors in the development of POA in adults, by avoiding these factors postoperative agitation can be minimized. Methods: 140 ASA 1 and 2 patients were randomly allocated to either premedication group that received Phenergan 25 mg IM and atropine 0.5mg IM or none premedication group that received an equal volume of water for injection intramuscular injection. Hypotensive anesthesia was induced by nitroglycerin 5 to 20 mcg/kg/minute. In postoperative care unit (PACU), patients were assessed for both agitation and pain using Richmond agitation sedation scale and numerical rating scale respectively. Data were analyzed and compared between groups, P<0.05 was considered significant. Results: Agitation was more frequent in the premedication group; premedicated patients showed a higher incidence of agitation versus the control group 82% versus 35% respectively P<0.0001.Postoperative agitation was more frequent in young ages, males, smokers and was correlated with pain. No correlation was found with BIS value or postoperative O2. Conclusion: premedication with atropine and Phenergan, Pain, smoking, young age, male gender was identified as risk factors for the development of postoperative agitation in adults following FESS.