Effects Of Preoperative Intravenous Injection Of Butorphanol Tartrate On Emergence Agitation In Patients Undergoing Endoscopic Sinus Surgery

ObjectiveTo observe the effect of preoperative intravenous infusion of butorphanol tartrate on the incidence of emergence agitation in patients undergoing endoscopic sinus surgery.MethodsPatients of with ASA I-II elective endoscopic sinus surgery were randomly divided into two groups:butorphanol tartrate group?20?g/kg intravenous injection,1 mg/mL,n=50?;Control group?injection of same volume of saline,n=50?.Anesthesia induction including propofol 2 mg/kg,fentanyl 3?g/kg and rocuronium 0.6 mg/kg in general anesthesia.Anesthesia was maintained by Intraoperative sevoflurane and remifentanil.Vasoactive drugs were used to maintain hemodynamic changes within 20%of the baseline fluctuation.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 after agitating,and it can be repeated if necessary until they were awake and then remove the catheter.The following data were recorded:1)general situation of the patients;2)the mean arterial pressure?MAP?and heart rate?HR?were recorded before inductionT₀,intubationT₁,immediateT₂,extubationT₃,and leave PACUT_4;the usage of remifentanil and vasoactive drugs;3)the patient's spontaneous breathing recovery time,language instruction response time,extubation time and PACU stay time;4)patient's SAS scores,cough scores,pain scores,and nausea and vomiting scores;5)the incidence of emerengce agitation and the usage of propofol;6)the quality of QoR-40 resuscitation was investigated befor the surgery and 24hours after surgery.Results1.The incidence of emergence agitation in Group butorphanol is 26%,and among these69.2%experienced mild agitation,30.8%moderate agitation,and 0%severe agitation;the incidence of emergence agitation in Group saline is 48%,and among these 29.2%experienced mild agitation,58.3%moderate agitation,and 12.5%severe agitation.Butorphanol can significantly reduce the incidence of emergence agitation.2.The time to extubation is 15.0±6.0min in Group butorphanol and 17.8±7.7min in Group saline?P<0.05?;the time stay in PACU is 59.6±6.9min in Group butorphanol and58.4±7.8min in Group saline?P>0.05?.3.The number of times of using propofol is 1.5±0.6 in Group butorphanol and 3.3±0.7in Group saline;the amount of usage of propofol is 58.2±15.8mg in Group butorphanol and110±55.6mg in Group saline.The result is statistically significant.The number of times of using propofol and dosage were significantly reduced in Group butorphanol.4.The HR and MAP at T ₃?extubation?in group butorphanol and group saline are significant difference?89.8±12.9?/min vs 110.4±13.4?/min;81.2±13.3mmHg vs 91.9±14.9mmHg?Conclusion:Intravenous injection of butorphanol tartrate can significantly reduce the incidence of emergence agitation and provide more stable haemodynamic changes during extubation in patients undergoing endoscopic sinus surgery.Meanwhile it did not extend the length of extubation and PACU stay and reduce the amount of usage of sedative drugs.