Background: This study aims to define incidence and risk factors of both emergence agitation and hypoactive emergence in adult patients and substance dependent patients following general anesthesia to elaborate the risk factors and precise management of them.Methods: 1136 adult patients underwent elective surgeries under general anesthesia were recruited in this prospective observational study. Inadequate emergence was determined according to the Richmond Agitation-Sedation Scale (RASS). Emergence agitation was defined as a RASS≥ +1 point, and hypoactive emergence was defined as a RASS≤ -2 points. Subgroup analyses were then conducted on patients with substance dependence.Results: Inadequate emergence in the PACU occurred in 20.3% patients including 13.9% patients with emergence agitation and 6.4% patients with hypoactive emergence. There were 95 patients with a history of substance dependence. The single and married patients undergoing gynecological and thoracic surgeries had a lower risk of agitation compared to the divorced patients. Neurologic disorders, intraoperative blood loss, intraoperative morphine, and analgesic drugs administration in PACU were associated with increased risk of agitation. Hypertension and psychological disorders, intraoperative opioids and Foley catheter fixation in PACU were associated with increased risk of hypoactive emergence. Substance dependent patients were at a higher risk for agitation (21.1%, P = 0.019) and hypoactive emergence (10.5%, P = 0.044). Conclusions:Inadequate emergence in PACU following general anesthesia is a significant problem that is correlated with several perioperative factors. It seems that patients with a history of substance dependence are more at the risk of inadequate emergence than normal population. This article is

Acetaminophen and diclofenac are prescribed as postoperative analgesic agents in children. However, the efficacy of their combination is not studied sufficiently. We compare the analgesic effects of acetaminophen, diclofenac, and their combination after cleft palate surgery. In this randomized clinical trial, 120 children (1.5-5 y) who were scheduled for cleft palate repair were studied. Children were randomized to receive placebo, acetaminophen (40 mg/kg), diclofenac (1 mg/kg), or acetaminophen (40 mg/kg) plus diclofenac (1 mg/kg) rectally just after surgery. Acetaminophen (30 mg/kg) and diclofenac (1 mg/kg) were administered every 8 hours until 48 hours. Postoperative pain was assessed regularly with the Children Hospital of Eastern Ontario Pain Scale, and rescue analgesia was provided if scores were 7 or greater. Time to the first prescription of meperidine, total postoperative meperidine consumption, and adverse effects were the main outcomes.After surgery, pain scores were higher in placebo than in other groups in all time intervals. In the first 12 hours, pain scores in the combined group were less than those in the acetaminophen (P < 0.05) and diclofenac (P < 0.05) groups. Postoperative meperidine consumption was the highest in placebo and was the least in combined group (P < 0.05). It was significantly higher in the acetaminophen group than in the diclofenac group (P < 0.05). Time to the first prescription of meperidine was significantly different among all groups. Adverse effects were comparable among groups.Rectal acetaminophen plus diclofenac was found to be the most effective in pain control. However, both rectal acetaminophen and diclofenac were more effective than placebo, whereas diclofenac was more effective than acetaminophen.

The present study demonstrated that the Persian version of the BPI could be a valid and reliable instrument for pain assessment in Persian-speaking patients.