Predictive Value of Preoperative Profiling of Serum Metabolites for Emergence Agitation After General Anesthesia in Adult Patients

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.

Identification of Serum Biomarkers Associated With Emergence Agitation After General Anesthesia in Adult Patients: A Metabolomics Analysis

“…The study was conducted at Peking University Third Hospital between 01 June 2020 and 30 December 2020. Eligible patients were >18 years of age, had American Society of Anesthesiologists (ASA) physical class of I–III, received elective surgery under general anesthesia with radial artery catheterized pre-anesthesia for constant monitoring of arterial blood pressure, and were transferred to the postanesthesia care unit (PACU) after surgery, which shared the same population as previously described ( 14 ). A total of 6,476 patients were admitted to the PACU with radial artery catheterization during the study period, of whom 24 patients developed EA evaluated by Richmond Agitation-Sedation Scale (RASS) ≥ + 2.…”

“…Nevertheless, few studies have employed metabolomics analyses to examine EA in adult patients after general anesthesia. We had previously performed a metabolomic study to explore the correlation between the preoperative serum level of metabolites and postoperative EA ( 14 ). Several altered metabolites in serum before surgery may have predictive value for EA diagnosis.…”

A Cross-Sectional Survey on the Clinical Management of Emergence Delirium in Adults: Knowledge, Attitudes, and Practice in Mainland China

“…Emergence delirium (ED) refers to the very early onset of postoperative delirium (POD) in the immediate post-anesthesia period, before or on arrival to the recovery room [ 1 ]. Such delirium may become dangerous and lead to several adverse consequences, including injury, hemorrhage, self-extubation, removal of catheters, or prolonged cognitive dysfunction [ 2 , 3 ]. According to the European Society of Anesthesiology (ESA), in its evidence- and consensus-based guideline for the prevention and treatment of POD, ED can present in hyperactive (referred to as emergence agitation), hypoactive (referred to as hypoactive emergence), or mixed forms [ 4 ].…”

Pre-anesthetic use of butorphanol for the prevention of emergence agitation in thoracic surgery: A multicenter, randomized controlled trial

“…General anesthesia (GA) is the most widely used anesthesia method in various types of surgery, and it has been recognized that emergence agitation (EA) is a common, serious complication after GA (1)(2)(3). EA is an inappropriate behavior during the awakening period of anesthesia, manifested by coexisting excitement, disorientation, and some inappropriate behaviors (4,5).…”