Emergence agitation in adults: risk factors in 2,000 patients

Abstract

Purpose The study was designed to determine the incidence of postoperative agitation following general anesthesia in 2,000 adult patients and to examine the associated risk factors. Methods The study enrolled 2,000 adults who were scheduled for surgery under general anesthesia in a single institution during December 2007 to December 2008. The following risk factors were examined: age, gender, ASA physical status, type of surgery, anesthesia technique (inhalational or intravenous), administration of neostigmine or doxapram, adequate postoperative analgesia, pain, presence of a tracheal tube, and presence of a urinary catheter. Results Agitation occurred in 426 patients (21.3%). It was more common in males (28.1%) than in females (16.1%) (P = 0.017) and more prevalent after inhalational (27.8%) than total intravenous (7.5%) anesthesia (P = 0.001). Agitation was more common after oral cavity and otolaryngological surgery than after other types of surgery. Multivariate analysis showed that use of doxapram (odds ratio [OR] = 9.2; 95% confidence interval [CI] = 6.2 -15.4; P = 0.002) and pain (OR = 8.2; 95% CI = 4.5 -16.9; P \ 0.001) were the most important risk factors associated with emergence agitation. Other causes were the presence of a tracheal tube and/or a urinary catheter. Adequate postoperative analgesia was associated with less agitation (OR = 0.4; 95% CI = 0.1 -0.4; P = 0.006). Conclusion Doxapram administration, pain, and presence of a tracheal tube and/or a urinary catheter appear to be the most important causes of postoperative agitation. To avoid this complication, it is suggested, whenever possible, to use intravenous anesthesia, to remove endotracheal tubes and urinary catheters as early as possible, and to provide adequate postoperative analgesia. RésuméObjectif Cette e´tude a e´te´conçue afin de de´terminer l'incidence d'agitation postope´ratoire apre`s une anesthe´sie ge´ne´rale chez 2000 patients adultes et d'examiner les facteurs de risque associe´s. Méthode L'e´tude a recrute´2000 adultes devant subir une chirurgie sous anesthe´sie ge´ne´rale dans une seule institution entre de´cembre 2007 et de´cembre 2008. Les facteurs de risque suivants ont e´te´examine´s: l'aˆge, le sexe, le statut physique ASA, le type de chirurgie, la technique anesthe´sique (par inhalation ou intraveineuse), l'administration de ne´ostigmine ou de doxapram, une analge´sie postope´ratoire adapte´e, la douleur, la pre´sence d'une sonde endotrache´ale et la pre´sence d'un cathe´ter urinaire. Résultats Au total, 426 patients ont montre´des signes d'agitation (21,3 %). Elle e´tait plus courante chez les hommes (28,1 %) que chez les femmes (16,1 %) (P = 0,017) et plus pre´valente apre`s une anesthe´sie par inhalation (27,8 %) qu'apre`s une anesthe´sie re´alise´e exclusivement par intraveineuse (7,5 %) (P = 0,001). L'agitation e´tait plus fre´quente apre`s une chirurgie otorhinolaryngologique ou de la cavite´orale qu'apre`s d'autres types de chirurgie. Une analyse multivarie´e a montre´que l'utilisation de doxapram (rappo...

Comparative study of emergence agitation between isoflurane and propofol anesthesia in adults after closed reduction of distal radius fracture

“…This is considered to be related to the reduction in occurrence of emergence agitation. Some studies have suggested that postoperative pain can be a risk factor related to emergence agitation (Yu et al, 2010), and there are also numerous reports suggesting that there is no relationship between pain control and emergence agitation (Zhao et al, 2012). Our study confirmed the latter, as there was no correlation between the patient's NRS score and AFPS score and no significant difference in the amount of fentanyl administered between the 2 groups.…”

“…Yu et al (2010) reported 21.3% and Radtke et al (2010), 5%, whereas in our study, it was 20%. The difference in incidence of emergence agitation according to investigator is considered to be due to differences in criteria or differences in the standards used to define emergence agitation, where AFPS, Riker Sedation-Agitation Scale, Richmond Agitation-Sedation Scale, or personally categorized criteria have been used.…”

“…The difference in incidence of emergence agitation according to investigator is considered to be due to differences in criteria or differences in the standards used to define emergence agitation, where AFPS, Riker Sedation-Agitation Scale, Richmond Agitation-Sedation Scale, or personally categorized criteria have been used. Yu et al (2010) found that the incidence of emergence agitation was lower in the group that received iv anesthetics than the group that received sevoflurane. In our study, the propofol group had a lower incidence of emergence agitation compared to the sevoflurane group.…”

Methods and madness: agitation, delirium, and postoperative cognitive dysfunction

“…Their study results indicate that [ 20% of adult subjects experienced postanesthetic agitation. 3 Delirium, POCD, agitation-the variety of cognitive disorders studied in the perioperative period can be…well…rather confusing. Often the terms are defined poorly and sometimes they are used interchangeably.…”

“…They then graded agitation according to the following scheme: a) mild: in response to stimulation; b) moderate: occurring without stimulation and lasting for at least five minutes but not requiring intervention; and, c) severe: lasting for at least five minutes and requiring drugs and/or physical restraint. 3 Using this definition, Yu found that 212 of 2,000 adult subjects (10.6%) experienced mild agitation, 178 (8.9%) experienced moderate agitation, and 36 (1.8%) experienced severe agitation. The frequency of agitation noted in the present study was fourfold greater than previous research in adults.…”