Emergence delirium is a frequent occurrence following general anaesthesia, especially in paediatric population. However it is less frequently described in adult patients. There are various factors which can lead to its etiology and have to be timely detected so as to prevent the serious mishaps to the patients. We will be describing a patient, operated for laparoscopic cholecystectomy, who developed severe agitation following extubation, and which was relieved on removing the nasogastric tube. We will be discussing the other potential causes of emergence delirium and its pathophysiology.

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Abstract

Background: Levobupivacaine has been claimed to have safer cardiovascular profile. However, single injection intrathecally produces limited duration of surgical anaesthesia. Hence we comparatively evaluated the effects of adding fentanyl to levobuivacaine and bupivacaine on spinal anaesthesia characteristics. Methods: 50 American Society of Anaesthesiologists grade I-II patients undergoing lower abdominal and lower limb surgeries were divided into two groups of 25 patients each. Intrathecally, 20µgm fentanyl was given with 2.6 ml of levobupivacaine (group L) or bupivacaine (Group B). Results: There was no significant difference between the two groups on time of onset and time taken to reach the maximum sensory block level. There was also no significant difference on the maximum levels of sensory block attained between the two groups. The duration of sensory regression to S1 was 262.80±20.13 minutes in group L, while it was 272.40±19.43 minutes in group B (p=0.09). Rescue analgesia was given at 219.80±24.26 minutes in group L, and at 230.00±19.58 minutes in group B (p=0.1). The duration of motor block was 215.60±22.56 minutes in group L, and 217.24±27.04 minutes in group B (p=0.82). Conclusion: Our study demonstrated no significant difference existed on time of onset and time taken to reach the maximum sensory block level when fentanyl was added to intrathecal isobaric levobupivacaine or bupivacaine. No significant difference existed on the maximum levels of sensory block attained between the two groups, as well as on the duration of sensory and motor blocks.