A Prospective Observational Single Center Study Evaluating Emergence Agitation in the Early Postoperative Period in Adult Patients Undergoing Elective Craniotomies Under General Anesthesia

Overview

Journal J Anaesthesiol Clin Pharmacol

Specialty Anesthesiology

Date 2023 May 30

PMID 37250235

Authors

Joseph N Monteiro

Ninad S Dhokte

Shwetal U Goraksha

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Emergence agitation is a significant clinical issue during recovery from general anesthesia. Patients after intracranial operations are even more vulnerable to the stress resulting from emergence agitation. Due to the limited data available in neurosurgical patients, we evaluated the incidence, risk factors, and complications of emergence agitation.

Material And Methods: 317 consenting eligible patients undergoing elective craniotomies were recruited. The preoperative Glasgow Coma Scale (GCS)) and pain score were recorded. Bispectral Index (BIS) guided balanced general anesthesia was administered and reversed. Immediate postoperatively, the GCS and the pain score were noted. The patients were observed for 24 hours following extubation. The levels of agitation and sedation were evaluated by the Riker's Agitation-Sedation Scale. Emergence Agitation was defined as Riker's Agitation score of 5 to 7.

Results: In our subset of the patient population, the incidence was 5.4%, mildly agitated in the first 24 hours and none required sedative medication as therapy. The sole risk factor identified was prolonged surgery beyond 4 hours. None of the patients in the agitated group had any complications.

Conclusion: Early objective assessment of risk factors in the preoperative period with objective validated tests and shorter duration of surgery maybe the way forward in patients at high risk for emergence agitation, to reduce the incidence and mitigate the undesirable consequences.

References

Silverstein J, Timberger M, Reich D, Uysal S . Central nervous system dysfunction after noncardiac surgery and anesthesia in the elderly. Anesthesiology. 2007; 106(3):622-8. DOI: 10.1097/00000542-200703000-00026. View

Bilotta F, Lauretta M, Borozdina A, Mizikov V, Rosa G . Postoperative delirium: risk factors, diagnosis and perioperative care. Minerva Anestesiol. 2013; 79(9):1066-76. View

Liu Z . [Analysis of risk factors for emergence agitation in adults undergoing general anesthesia for nasal surgery]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016; 29(21):1881-5. View

Khan B, Guzman O, Campbell N, Walroth T, Tricker J, Hui S . Comparison and agreement between the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale in evaluating patients' eligibility for delirium assessment in the ICU. Chest. 2012; 142(1):48-54. PMC: 3610594. DOI: 10.1378/chest.11-2100. View

Makarem J, Larijani A, Eslami B, Jafarzadeh A, Karvandian K, Mireskandari S . Risk factors of inadequate emergence following general anesthesia with an emphasis on patients with substance dependence history. Korean J Anesthesiol. 2019; 73(4):302-310. PMC: 7403114. DOI: 10.4097/kja.19214. View

Tarnal V, Vlisides P, Mashour G . The Neurobiology of Anesthetic Emergence. J Neurosurg Anesthesiol. 2015; 28(3):250-5. PMC: 4752918. DOI: 10.1097/ANA.0000000000000212. View

Citerio G, Pesenti A, Latini R, Masson S, Barlera S, Gaspari F . A multicentre, randomised, open-label, controlled trial evaluating equivalence of inhalational and intravenous anaesthesia during elective craniotomy. Eur J Anaesthesiol. 2012; 29(8):371-9. DOI: 10.1097/EJA.0b013e32835422db. View

ROSE D . Recovery room problems or problems in the PACU. Can J Anaesth. 1996; 43(5 Pt 2):R116-28. DOI: 10.1007/BF03011674. View

Kudoh A, Takase H, Takahira Y, Takazawa T . Postoperative confusion increases in elderly long-term benzodiazepine users. Anesth Analg. 2004; 99(6):1674-1678. DOI: 10.1213/01.ANE.0000136845.24802.19. View

10.

Bilotta F, Doronzio A, Stazi E, Titi L, Zeppa I, Cianchi A . Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial--the PINOCCHIO trial. Trials. 2011; 12:170. PMC: 3155116. DOI: 10.1186/1745-6215-12-170. View

11.

Sessler C, Gosnell M, Grap M, Brophy G, ONeal P, Keane K . The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002; 166(10):1338-44. DOI: 10.1164/rccm.2107138. View

12.

Hargrave A, Bastiaens J, Bourgeois J, Neuhaus J, Josephson S, Chinn J . Validation of a Nurse-Based Delirium-Screening Tool for Hospitalized Patients. Psychosomatics. 2017; 58(6):594-603. PMC: 5798858. DOI: 10.1016/j.psym.2017.05.005. View

13.

Radtke F, Franck M, Hagemann L, Seeling M, Wernecke K, Spies C . Risk factors for inadequate emergence after anesthesia: emergence delirium and hypoactive emergence. Minerva Anestesiol. 2010; 76(6):394-403. View

14.

Chen L, Xu M, Li G, Cai W, Zhou J . Incidence, Risk Factors and Consequences of Emergence Agitation in Adult Patients after Elective Craniotomy for Brain Tumor: A Prospective Cohort Study. PLoS One. 2014; 9(12):e114239. PMC: 4262354. DOI: 10.1371/journal.pone.0114239. View

15.

Yan L, Chen H, Yu R, Wang Z, Zhou G, Wang Y . Emergence agitation during recovery from intracranial surgery under general anaesthesia: a protocol and statistical analysis plan for a prospective multicentre cohort study. BMJ Open. 2015; 5(4):e007542. PMC: 4410113. DOI: 10.1136/bmjopen-2014-007542. View

16.

Dube S, Pandia M, Chaturvedi A, Bithal P, Dash H . Comparison of intraoperative brain condition, hemodynamics and postoperative recovery between desflurane and sevoflurane in patients undergoing supratentorial craniotomy. Saudi J Anaesth. 2015; 9(2):167-73. PMC: 4374222. DOI: 10.4103/1658-354X.152866. View

17.

Lepouse C, Lautner C, Liu L, Gomis P, Leon A . Emergence delirium in adults in the post-anaesthesia care unit. Br J Anaesth. 2006; 96(6):747-53. DOI: 10.1093/bja/ael094. View

18.

Evered L, Silbert B . Postoperative Cognitive Dysfunction and Noncardiac Surgery. Anesth Analg. 2018; 127(2):496-505. DOI: 10.1213/ANE.0000000000003514. View

19.

Ramroop R, Hariharan S, Chen D . [Emergence delirium following sevoflurane anesthesia in adults: prospective observational study]. Braz J Anesthesiol. 2019; 69(3):233-241. PMC: 9391875. DOI: 10.1016/j.bjan.2018.12.003. View

20.

Pol R, van Leeuwen B, Visser L, Izaks G, van den Dungen J, Tielliu I . Standardised frailty indicator as predictor for postoperative delirium after vascular surgery: a prospective cohort study. Eur J Vasc Endovasc Surg. 2011; 42(6):824-30. DOI: 10.1016/j.ejvs.2011.07.006. View