Risk Factors of Emergence Agitation in Adults Undergoing General Anesthesia for Nasal Surgery

Abstract

ObjectivesTo identify the incidence and the risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery.MethodsWe retrospectively examined 792 patients aged ≥18 years who underwent general anesthesia for elective nasal surgery between July 2012 and August 2013. Patients in the postanesthesia care unit with a Richmond Agitation Sedation Scale≥+1 at any time were considered to have emergence agitation.ResultsThe overall incidence of emergence agitation is 22.2%. From multivariate regression analysis, the following six variables were found to be significantly associated with emergence agitation (P<0.05): younger age, recent smoking, sevoflurane anesthesia, postoperative pain on the numerical rating scale (NRS)≥5, presence of a tracheal tube, and presence of a urinary catheter. Presence of a tracheal tube was the greatest risk factor, increasing the risk of developing emergence agitation by approximately fivefold (odds ratio, 5.448; 95% confidence interval, 2.973 to 9.982). Younger age was also a strong risk factor (odds ratio, 0.975 for each 1-year increase; 95% confidence interval, 0.964 to 0.987). Current smoking, sevoflurane anesthesia, postoperative pain of NRS≥5, and the presence of a urinary catheter nearly doubled the risk of emergence agitation.ConclusionEmergence agitation following general anesthesia is a common complication in adult nasal surgery patients. To reduce the occurrence and consequences of agitation episodes, elimination of the associated risk factors is necessary, especially in at-risk patients.

Dexmedetomidine for prevention of delirium in elderly patients after non-cardiac surgery: a randomised, double-blind, placebo-controlled trial

“…The fi rst assessment of postoperative (also referred to as interval) delirium was done around 24 h after surgery; 20 we selected the timing of the fi rst assessment to avoid diagnosing emergence delirium that can occur immediately after general anaesthesia and is not associated with adverse outcomes. 21,22 Twice daily (in the morning from 0800 h to 1000 h and in the evening from 1800 h to 2000 h) until the seventh day after surgery, we assessed delirium by the Confusion Assessment Method for the ICU (CAM-ICU); (appendix), 23 which has been validated in Chinese patients in the ICU setting 24 and the feasibility of which had been established in our other studies. 25,26 CAM-ICU addresses the four features of delirium, namely, acute onset of mental status changes or a fl uctuating course, inattention, disorganised thinking, and altered level of consciousness.…”

Post-anaesthetic emergence delirium in adults: incidence, predictors and consequences

“…3 Depending on the patient population and methods used to diagnose ED, previous studies have reported incidences varying from 4.7 to 22.2% in the adult population. [4][5][6][7][8][9] Only one other study 5 has described the clinical consequences of this potentially harmful state, which involved catheter removal, attempts at self-extubation and injuries to the patients as well as the staff.…”

A Prospective Randomised Control Study to Assess the Efficacy of Intraoperative Dexmed Infusion on Emergence Agitation and Quality of Recovery in Nasal Surgery

“…Male gender, type of surgery, inhalation anaesthetics, presence of tracheal tube and preoperative benzodiazepine medication are risk factors for postoperative agitation in adults. Emergence agitation is especially common after ENT surgery, where 55.4% of patients experienced agitation 11 . High incidence of emergence agitation after ENT surgery may be attributable to a sense of suffocation.…”

“…The patient received IV midazolam (0.04 mg/kg) 5 minutes prior to induction. 11,12 Prior to induction Inj. glycopyrrolate 0.2 mg was given.…”