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Incidence, Risk Factors and Consequences of Emergence Agitation in Adult Patients after Elective Craniotomy for Brain Tumor: A Prospective Cohort Study.

ABSTRACT: UNLABELLED:Emergence agitation is a frequent complication that can have serious consequences during recovery from general anesthesia. However, agitation has been poorly investigated in patients after craniotomy. In this prospective cohort study, adult patients were enrolled after elective craniotomy for brain tumor. The sedation-agitation scale was evaluated during the first 12 hours after surgery. Agitation developed in 35 of 123 patients (29%). Of the agitated patients, 28 (80%) were graded as very and dangerously agitated. By multivariate stepwise logistic regression analysis, independent predictors for agitation included male sex, history of long-term use of anti-depressant drugs or benzodiazepines, frontal approach of the operation, method and duration of anesthesia and presence of endotracheal intubation. Total intravenous anesthesia and balanced anesthesia with short duration were protective factors. Emergence agitation was associated with self-extubation (8.6% vs 0%, P?=?0.005). Sedatives were administered more in agitated patients than non-agitated patients (85.7% vs 6.8%, P<0.001). In conclusion, emergence agitation was a frequent complication in patients after elective craniotomy for brain tumors. The clarification of risk factors could help to identify the high-risk patients, and then to facilitate the prevention and treatment of agitation. For patients undergoing craniotomy, greater attention should be paid to those receiving a frontal approach for craniotomy and those anesthetized under balanced anesthesia with long duration. More researches are warranted to elucidate whether total intravenous anesthesia could reduce the incidence of agitation after craniotomy. TRIAL REGISTRATION:ClinicalTrials.gov NCT00590499.

SUBMITTER: Chen L

PROVIDER: S-EPMC4262354 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Incidence, Risk Factors and Consequences of Emergence Agitation in Adult Patients after Elective Craniotomy for Brain Tumor: A Prospective Cohort Study.

Chen Lu L Xu Ming M Li Gui-Yun GY Cai Wei-Xin WX Zhou Jian-Xin JX

PloS one 20141210 12

<h4>Unlabelled</h4>Emergence agitation is a frequent complication that can have serious consequences during recovery from general anesthesia. However, agitation has been poorly investigated in patients after craniotomy. In this prospective cohort study, adult patients were enrolled after elective craniotomy for brain tumor. The sedation-agitation scale was evaluated during the first 12 hours after surgery. Agitation developed in 35 of 123 patients (29%). Of the agitated patients, 28 (80%) were g ...[more]

PMID: 25493435

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Project description:Postoperative agitation frequently occurs after general anesthesia and may be associated with serious consequences. However, studies in neurosurgical patients have been inadequate. We aimed to investigate the incidence and risk factors for early postoperative agitation in patients after craniotomy, specifically focusing on the association between postoperative pneumocephalus and agitation. Adult intensive care unit admitted patients after elective craniotomy under general anesthesia were consecutively enrolled. Patients were assessed using the Sedation-Agitation Scale during the first 24 hours after operation. The patients were divided into two groups based on their maximal Sedation-Agitation Scale: the agitation (Sedation-Agitation Scale ≥ 5) and non-agitation groups (Sedation-Agitation Scale ≤ 4). Preoperative baseline data, intraoperative and intensive care unit admission data were recorded and analyzed. Each patient's computed tomography scan obtained within six hours after operation was retrospectively reviewed. Modified Rankin Scale and hospital length of stay after the surgery were also collected. Of the 400 enrolled patients, agitation occurred in 13.0% (95% confidential interval: 9.7-16.3%). Body mass index, total intravenous anesthesia, intraoperative fluid intake, intraoperative bleeding and transfusion, consciousness after operation, endotracheal intubation kept at intensive care unit admission and mechanical ventilation, hyperglycemia without a history of diabetes, self-reported pain and postoperative bi-frontal pneumocephalus were used to build a multivariable model. Bi-frontal pneumocephalus and delayed extubation after the operation were identified as independent risk factors for postoperative agitation. After adjustment for confounding, postoperative agitation was independently associated with worse neurologic outcome (odd ratio: 5.4, 95% confidential interval: 1.1-28.9, P = 0.048). Our results showed that early postoperative agitation was prevalent among post-craniotomy patients and was associated with adverse outcomes. Improvements in clinical strategies relevant to bi-frontal pneumocephalus should be considered.Trial registrationClinicalTrials.gov (NCT02318199).

Project description:IntroductionEmergence agitation is a common problem that can occur after administration of general anesthesia and during recovery time especially in pediatric patients, which can result in life-threatening events if not managed adequately and timely. Usage of modern inhalational anesthetic agents like sevoflurane, isoflurane, and also halothane is a common cause for emergence agitation. Currently, the use of propofol is gaining acceptance largely on decreasing emergence agitation in addition to prevention of postoperative nausea and vomiting. The objective of this study was to assess the effectiveness of prophylaxis administration of propofol on incidence & severity of emergence agitation on pediatric patients undergo ENT & ophthalmic surgery under general anesthesia.Methods and materialAn institutional-based prospective cohort study was conducted on 90 patients. Patients who take 1 mg/kg of propofol were grouped into exposed while if propofol were not given grouped to non-exposed. Data were collected through intraoperative observation & by using WATCH & PAED score the patients were observed at 5, 15 & 30 min in the recovery room. Incidence of emergence agitation was analyzed by chi-square test & Mann Whitney U test was applied for the severity of emergence agitation. A P-value less than 0.05 was declared as statistically significant.ResultFrom a total of 90 study participants 64% of the non-exposed group & 31% of the exposed group were developed emergence agitation which was statistically significant with p = 0.002. The severity of agitation was also higher in the non-exposed group than the exposed group at 5, 15 & 30 min with p = 0.009, 0.013, and 0.011 respectively.ConclusionAdministering 1 mg/kg propofol before the end of surgery in pediatrics ENT & ophthalmic procedure under general anesthesia is effective in reducing incidence & severity of emergence agitation. Based on our findings we recommend using 1 mg/kg propofol at the end of surgery to reduce the occurrence of emergency agitation.

Project description:BackgroundThe differences in the incidence and severity of emergence agitation (EA) and emergence times between desflurane and sevoflurane anesthesia have not been as clearly elucidated in children as in adults.MethodsThe design of the study is a systematic review with meta-analysis of randomized controlled trials. The study methodology is based on the Cochrane Review Methods. A comprehensive literature search was conducted to identify clinical trials comparing the incidence or severity of EA and emergence times in children anesthetized with desflurane or sevoflurane. Two reviewers independently assessed each study according to predefined inclusion criteria and extracted data from each study using a prespecified data extraction form. The data from each study were combined using a fixed effect or random effect model to calculate the pooled risk ratio (RR) or standardized mean difference (SMD) and 95% confidence interval (CI). Funnel plots were used to assess publication bias. Subgroup and sensitivity analyses were performed.ResultsFourteen studies met the inclusion criteria. Among the 1196 patients in these 14 studies, 588 received desflurane anesthesia and 608 received sevoflurane anesthesia. The incidence of EA was comparable between the 2 groups (pooled RR = 1.21; 95% CI: 0.96-1.53; I = 26%), and so was the severity of EA (EA score) between the 2 groups (SMD = 0.12; 95% CI: -0.02 to 0.27; I = 0%). Extubation and awakening times were shorter in the desflurane group than in the sevoflurane group; the weighted mean differences were -2.21 (95% CI: -3.62 to -0.81; I = 93%) and -2.74 (95% CI: -3.80 to -1.69; I = 85%), respectively. No publication bias was found in the funnel plot. The subgroup analysis based on the type of EA scale showed a higher incidence of EA in the desflurane group than in the sevoflurane group in studies using 3-, 4-, or 5-point EA scales; the pooled RR was 1.38 (95% CI: 1.10-1.73; I = 37%).ConclusionThe incidence and severity of EA were comparable between desflurane and sevoflurane anesthesia in children; however, emergence times, including extubation and awakening times, were shorter in desflurane anesthesia.

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Incidence, Risk Factors and Consequences of Emergence Agitation in Adult Patients after Elective Craniotomy for Brain Tumor: A Prospective Cohort Study.

Publications

Incidence, Risk Factors and Consequences of Emergence Agitation in Adult Patients after Elective Craniotomy for Brain Tumor: A Prospective Cohort Study.

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