Emergence Agitation After Total Introvenus Or Inhalation Anesthesia For Maintenance With Remifentanil

IntroductionAfter the general anesthesia,most patients can wake up immediately.But brain dysfunetion appears in some patients,such as consciousness, lethargy, serious unorientation, and agitation. The data of epidemiological investigation showed that the incidence rate of adults was 5.3%,and the children was abont 12-13%,especially the preschool children, and the incidence rate of the aged was higher. So quiet a lot of patients need pharmacal intervention.Agitation during analepsia time is a common complication of general anaesthesia with desflurane and sevoflorane. Agitation is always self-limited,but hypertension, increased heart rate, pulling out drainage tube and tracheal catheter by oneself, and haemorrhage from the operative site, even apnea may happen. Especially,it is more dengerous for the patients of hypertension or coronary heart disease.At present,many reports concern about agitation after general anaesthesia with isoflurane and halothane. But little about desflurane and sevoflorane. Propofol, desflurane and sevoflorane were all general anesthetic to decurtate the recovery time, and each owns its merit in general anesthesia induction and the minor operation.Our stady aim at comparing the incidence rate of agitation during analepsia time with these three general anaesthesia drugs and to provide the basement of theory to select resonable dinicol anesthetil drugs.Materials1.Patients:Nity patients scheduled for radical operation of mastocarcinoma and tympanoplasty procedure ASAⅠ～Ⅱ, whose age were older than 18,were selected without sex limitation.All patients had no important organ dysfunction, and no history of excessive drinking, drug taking,drug abuse and mental disease.2. Main drugs:Propofol (AstraZeneca Pharmaceutical Limited Company);Remifentanil (Hubei Yichang Renfu pharmaceutical Limited Company);Fentanyl (Hubei Yichang Renfu pharmaceutical Limited Company);Sevoflurane(Beta medical treatment commerce Limited Company);Desflorane (AstraZeneca Pharmaceutical Limited Company);Midazolam (Jiangshu Enhua pharmaceutical Limited Company);Vecuronium(N.V. Organon).3. Main apparatus: All-round anaesthetic machine (Detax Ohmeda7000 American); Multifunction monitor (Detax Ohmeda S/5 American): intravenous transfusion pump (B.Braun micro-injection pump Germany); Aspect A-1000 BIS monitor; Datexe anesthesia gas monitor.Methods1. Grouping: 90 patients under general anesthesia were randomly divided into three groups. Propofol and remifentanil combination group (P group n=30); Desflurane and remifentanil combination group (D group n=30);and Sevoflorane and remifentanil combination group (S group n=30).2. Anesthesia method(1) Premedication of atropine 0.5mg was intramuscularly administered 30 minutes before operation. All patients were monitored with continuous electrocardiograph, pulse oximetry and multifunction BIS monitor. Anesthesia induction consisted of intravenous midazolam 2 mg, vecuronium 0.1-0.16 mg. kg^-1, Fentanil 3-4ug. kg^-1, After introduction, tracheal intubation was performed and mechanical ventilation were operated.(2) In the P group the continuous intravenous infusion of propofol at the dose of 4-6 mg.kg^-1.h^-1 were given.In the S group and Dgroup, 0.8 MAC of desflurane and sevoflorane were inhalated. The depth of anesthesia and analgesiain the three groups were controled by intravenous infusion of remifentanil, and BIS was maintained between 40 and 60.Based on the demand of operation, vecuroniumwas intermitted intravenous injected. Intravenous infusion of remifentanil was stopped 10 minutes before the end of operation, In the P group,propofol was stopped and in the S and D group, desflurane and sevoflorane were stopped at once in the end of operation.After the spontaneous breath recovered,and SpO2≥95% when breath in the air, muscle power recovered, the tracheal catheter was pulled out.3. Monitor index: The incidence rate of agitation,the time of openning eyes and the time of extubating were observed.The mean arterial blood pressure(MAP),heart rate (HR),SPO₂ and BIS value were recorded before the anesthesia induction, at the end of operation. and the happening of agitation and after the relieving of agitation. The score of agitation was recorded.Results1. General state: There were no significant difference of operation time, sex ratio,age, height,weight, operation categories,anesthesia time and dose of remifentanil in the three groups (P＞0.05).2. open-eye time and extubation time: open-eye time and extubation time were showed no significant variance among the three groups. Group P 9.07±4.75min,Group D 7.17±3.65min,Group S 7.27±2.61min.3. The score of agitation: The score of Group D was significantly higher than Group P(P＜0.05), Group S was significantly higher than Group P(P＜0.05), There were no significant difference between Group S and Group D (P＞0.05).4.The incidence of agitation: Group S was 20.00% and Group Dwas 17.24% during the recovery time,both of them were higher than Group P 0% (P＜0.05); There were no significant difference between Group S and Group D (P＞0.05).5. The mean arterial blood pressure(MAP),heart rate (HR),SPO₂.: After restlessness, BP and SpO₂ vary significantly compared to pre-agitation values (P＜0.05), while HR increased significantly associated with restlessness. (P＜0.01).ConclusionThe association of propofol with remifentanil for anesthesia maintenance resulted in a lower incidence of postoperative agitation compared with the association of desflurane or sevoflurane and remifentanil. There were no significant difference between Group S and Group D. MAP, HR incrased and SpO₂ decreased during agitation. Fortunately, agitation is olways self-limited, and relieved in two minutes.