Clinical Investigation Of Emergence Agitation In Adult Patients After General Anesthesia

Part one Comparative study between dexmedetomidine and sufentanil in the management emergence agitation in adult patientsObjective: To observe the incidence of emergence agitation in adults undergoing general anesthesia for non cardiac or neurologic surgery and investigate the effects of dexmedetomidine and sufentanil on emergence agitation in adult patients.Methods:1 Forty adult patients(no limitation on gender or weight,ASA physical statusⅠ~Ⅲ,without cardiac A-V block or severe hepatic and renal dysfunction)admitted to PACU suffering emergence agitation undergoing general anesthesia for non cardiac or neurologic surgery were randomly divided into two groups: group dexmedetomidine(group DEX,n=20)and group sufentanil(group SF,n=20).All patients were signed informed consent preoperatively.2 Patients were inhalated with oxygen and their vital signs were monitored after being admitted to PACU,a Riker sedation-agitation Score(SAS)were evaluated by a nurse,and patients were considered to have emergence agitation when SAS≥5.A single dose of propofol(0.5mg/kg)was injected immediately after agitating,then dexmedetomidine at a dose of 0.5μg/kg were infused to the patients for 10 min in group DEX,and sufentanil at a dose of 0.1ug/kg were injected slowly in group SF.If patients still agitate after above treatment,intermission infusion of propofol at a bolus of 0.5mg/kg was used until they were peaceful.3 The following data were recorded: 1)general situation of the patient;2)Time of waking up,duration of extubation(or LMA removal),time stayed in PACU;3)MAP、HR、RR、SpO2、SAS at different time(before medication T0、after medication 5min T1、10min T2、20min T3、30min T4、leaving from PACU T5);4)number of times and dosage of propofol and the incidence of adverse events.Results:1 The overall incidence of emergence agitation is 2.7%,and among these 7.2% experienced mild agitation,71.4% moderate agitation,and 21.4% severe agitation.2 The time of waking up is 26.7±14.5min in Group DEX and 35.7±20.3min in group SF,duration of extubation(or LMA removal)is 35.4±18.7min in group DEX and 38.7±20.4min in group SF,time stayed in PACU is 73.7±17.7min in group DEX and 81.7±28.2min in group SF.There is no significant difference between the two groups.3 The number of times of using propofol is 1.6±0.6 in group DEX and 3.0±1.9 in group SF(P=0.006).The dosage of using propofol is 52.0±18.6mg in group DEX and 103.5±74.4mg in group SF(P=0.005).The rate of respiratory depression in group DEX is more rare than that in group SF(P= 0.024).Conclusions:1 The incidence of emergence agitation in adults undergoing general anesthesia for non cardiac or military surgery is 2.7%.2 Single dose of dexmedetomidine can release emergence agitation effectively.The effect of DEX is better than that of sufentanil with rare adverse events.Part two Mechanism of emergence agitation and the relationship between emergence agitation and postoperative cognitive dysfunction in short-termObjective: To investigate the mechanism of emergence agitation and the relationship between emergence agitation and postoperative cognitive dysfunction in short-term.Methods:1 Forty emergence agitation patients were recruited into group EA and twenty adult patients without EA in PACU were included into group NEA.Patients in group EA were divided into group SF(n=20)and group DEX(n=20)according to the different interventions in part1.Informed consent were signed in all patients preoperatively.Exclusive criteria: 1)unable to communicate or do not complete the postoperative follow-up;2)a second operation or admitted to ICU in the postoperative seven days.2 Venous blood sample were collected at agitating time(T0)in group EA and admisson time to PACU in group NEA(T0).Concentrations of S100β protein were detected using the ELISA method.The cognitive state was evaluated by a doctor blind to group situation at 1,3 and 7 day(D1,D3,D7)after operation using MMSE.Patients with a MMSE score reduction of more than 2 were diagnosed with POCD.Results:1 The incidence of POCD is 42.50% in group EA and 15.00% in group NEA(P=0.03).2 The concentration of S100β protein at T0 is 496.45±292.26pg/ml in group EA and 339.32±179.48pg/ml in group NEA(P=0.046).3 There is no significant difference on the incidence of POCD between group DEX and group SF.Conclusions: Brain injure maybe contribute to emergence agitation and there are relationshipe between emergence agitation and postoperative cognitive dysfunction.