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

Abstract

BackgroundEmergence agitation (EA) is common in patients after general anesthesia (GA) and is associated with poor outcomes. Patients with thoracic surgery have a higher incidence of EA compared with other surgery. This study aimed to investigate the impact of pre-anesthetic butorphanol infusion on the incidence of EA in patients undergoing thoracic surgery with GA.Materials and methodsThis prospective randomized controlled trial (RCT) was conducted in 20 tertiary hospitals in China. A total of 668 patients undergoing elective video-assisted thoracoscopic lobectomy/segmentectomy for lung cancer were assessed for eligibility, and 620 patients were enrolled. In total, 296 patients who received butorphanol and 306 control patients were included in the intention-to-treat analysis. Patients in the intervention group received butorphanol 0.02 mg/kg 15 min before induction of anesthesia. Patients in the control group received volume-matched normal saline in the same schedule. The primary outcome was the incidence of EA after 5 min of extubation, and EA was evaluated using the Riker Sedation-Agitation Scale (RSAS). The incidence of EA was determined by the chi-square test, with a significance of P < 0.05.ResultsIn total, 296 patients who received butorphanol and 306 control patients were included in the intention-to-treat analysis. The incidence of EA 5 min after extubation was lower with butorphanol treatment: 9.8% (29 of 296) vs. 24.5% (75 of 306) in the control group (P = 0.0001). Patients who received butorphanol had a lower incidence of drug-related complications (including injecting propofol pain and coughing with sufentanil): 112 of 296 vs. 199 of 306 in the control group (P = 0.001) and 3 of 296 vs. 35 of 306 in the control group (P = 0.0001).ConclusionThe pre-anesthetic administration of butorphanol reduced the incidence of EA after thoracic surgery under GA.Clinical trial registration[http://www.chictr.org.cn/showproj.aspx?proj=42684], identifier [ChiCTR1900025705].

Effects of Remimazolam and Propofol on Emergence Agitation in Elderly Patients Undergoing Hip Replacement: A Clinical, Randomized, Controlled Study

“… 4 Gao et al found that the incidence of EA in patients using propofol during general anesthesia can be up to 34%, 5 which leads to an increase in postoperative adverse events such as incisional dehiscence, tracheal tube displacement, falling off the bed, and cardiovascular events. 6 In severe cases, EA can also lead to self-harm, or violence against medical staff. 7 Remimazolam is a new anesthetic sedative with an ultra-short half-life that is metabolized by non-specific plasma esterases and does not accumulate during general anesthesia, 8 , 9 moreover, it has very slight hemodynamic impact.…”