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Purpose: To explored the impact of dexmedetomidine and esketamine in mitigating restlessness during the postoperative recovery phase following laparoscopic surgery in children. Methods: 102 individuals aged 1 to 7 years experiencing laparoscopic surgery were randomly allocated into three groups, each accepting 1 μg/kg of dexmedetomidine, 0.3 mg/kg of esketamine, or saline immediately at the end of carbon dioxide pneumoperitoneum. Emergence agitation (EA) occurrence was assessed by PAED scale and 5-point agitation scale. Pain was judged using Face, Legs, Activity, Cry, and Consolability (FLACC) scale. The recovery time, extubation time, and post-anesthesia care unit (PACU) stay time were recorded for all three groups. Results: Patients administered 1 μg/kg of dexmedetomidine (8.8%) and individuals given 0.3 mg/kg of esketamine (11.8%) showed lower incidences of emergence agitation compared to those receiving saline (35.5%; P = 0.009). There was no statistically significant difference in the time to discharge from the PACU among the three groups of patients (P > 0.05). The recovery time and extubation time were notably extended in the dexmedetomidine group (40.88 ± 12.95 min, 42.50 ± 13.38 min) when compared to the saline group (32.56 ± 13.05 min, 33.29 ± 11.30 min; P = 0.009, P = 0.010). Conclusion: Following CO2 pneumoperitoneum in pediatric laparoscopic surgeries, the intravenous administration of 1 μg/kg dexmedetomidine or 0.3 mg/kg esketamine effectively lowers EA occurrence without extending PACU time. [ABSTRACT FROM AUTHOR]

Background: Emergence agitation EA is a state of confusion and harmful aggressiveness during recovery. It is a common complication after rhinoplasty, with risk of trauma, bleeding, and hemodynamic instability. Dexmedetomidine and gabapentin premedication could improve the quality of recovery after rhinoplasty. Methods: One hundred fifty-three participants (ASA I-II, both sexes and age 18–40 years) scheduled for rhinoplasty were randomized into three groups. Group C didn't receive premedication, Group D received intramuscular (IM) dexmedetomidine, and Group G received oral gabapentin. The degree of EA by Riker sedation-agitation scale (RSAS) during recovery, pain severity, and adverse events recorded. Results: The results showed statistically significant differences in EA scores with the lowest values in group D (p-value 0.002). Moreover, the incidence of EA was 17.6% (9/51) in Group D, 41.2% (21/51) in Group G, and 56.9% (29/51) in Group C with P value < 0.001 and significant differences in VAS score at 4, 8, and 12 h with the highest median (range) values in group C 4(3–6) in comparison to group D 2(1–3) and group G 2(1–3) and p-value < 0.001; no significant differences in adverse events. Conclusions: IM dexmedetomidine premedication was more efficient than gabapentin in the reduction of the emergence agitation incidence, severity, and postoperative pain scores after rhinoplasty in adults. Clinical trial registration number ID: NCT05626998 on 25/11/2022. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of esketamine combined with ultrasound-guided glossopharyngeal nerve block on emergence agitation (EA) during the recovery period following pediatric tonsillectomy. Methods Totally 105 children undergoing tonsillectomy were selected and randomly divided into three groups (G, S, and C) using a random number table, with 35 patients in each group. In the group S, esketamine 0. 25 mg/kg was intravenously administered during anesthesia induction. Children in the groups G and C received an equivalent volume of normal saline. Following induction, children in both the group G and group S received glossopharyngeal nerve blocks. Anesthetic induction and maintenance methods were consistent across all groups. Emergence agitation was assessed using the Pediatric Anesthesia Emergence Delirium (PAED) scale at extubation (T2),10 minutes after extubation (T3), 20 minutes after extubation (T4), and 30 minutes after extubation (T5). Sedation levels were evaluated using the Ramsay Sedation Scale (RSS), and pain levels were assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Serum levels of interleukin6(IL-6) and tumor necrosis factor-α(TNF-α) were measured by enzyme-linked immunosorbent assay (ELISA) at preanesthesia (T0) and immediately post-surgery (T1). Heart rate (HR) and mean arterial pressure (MAP) were recorded at T2, T3, T4, and T5 for all groups. Postoperative rescue sedation and analgesia usage were documented, as well as the adverse reactions within 24 h after surgery. Results The incidence of emergence agitation in groups C, G, and S was 51. 43% (18/35),22. 86% (8/35), and 5. 71% (2/35), respectively, with statistically significant differences between the groups (all P<0. 05). PAED scores gradually decreased at T2, T3, T4, and T5 in all three groups. Compared with group C, the PAED scores in the groups G and S were lower at T2, T3, T4, and T5(all P<0. 05). Additionally, PAED scores in the group S were lower than those in the group G at T2, T3, T4, and T5(all P<0. 05). Group G and group S had significantly higher Ramsay scores than the group C at T2, T3, T4, and T5(all P<0. 05), and Group S had significantly higher Ramsay scores than the group G at T2, T3, T4, and T5(all P<0. 05). FLACC scores gradually decreased in all groups from T2 to T5. Group G and group S had significantly lower FLACC scores than the group C at T2, T3, T4, and T5 (all P<0. 05), and Group S had lower FLACC scores than the group G at all time points (all P<0. 05). At T0, there were no significant differences in the serum IL-6 or TNF-α levels among the three groups (all P>0. 05). At T1, the serum IL-6 and TNF-α levels in all groups were higher than those at T0(all P<0. 05). Group G and group S had significantly lower serum levels of IL-6 and TNF-α than the group C at T1(all P<0. 05). Group S had significantly lower lower IL-6 and TNF-α levels than the group G at T1(all P<0. 05). At T2, T3, T4, and T5, there were no significant differences in heart rate (HR) and mean arterial pressure (MAP) either within or between groups (all P>0. 05). There were significant differences in the postoperative rescue sedation and rescue analgesia rates among the three groups (all P<0. 05). The rescue sedation and analgesia rates were lower in the groups G and S than in the group C (all P<0. 05), but there were no significant differences between groups G and S (all P>0. 05). No adverse reactions such as bleeding, laryngeal spasm, or hoarseness occurred in the three groups within 24 h postoperatively. There were no significant differences in the incidence of nausea and vomiting, respiratory depression, or foreign body sensation in the throat (all P>0. 05). Conclusion Glossopharyngeal nerve block combined with esketamine significantly reduces the incidence of emergence agitation in children after tonsillectomy, improves the effects of sedation and analgesia, alleviates inflammatory responses, and does not increase the incidence of adverse reactions. [ABSTRACT FROM AUTHOR]

Background: Remimazolam is a novel intravenous sedative/anesthetic drug that belongs to the ultra-short-acting class of benzodiazepines. The purpose of this study was to evaluate the effectiveness of postoperative use of remimazolam in preventing emergence agitation (EA) in adults following nasal surgery. Methods: Patients who underwent nasal surgery were randomly divided into Group R and Group C. Propofol, sufentanil, and cis-atracurium were used for the induction of anesthesia, and 1.5–3.5% sevoflurane was used for the maintenance of anesthesia. At the end of the surgery, patients were randomly assigned to receive either remimazolam 0.1 mg kg− 1 (Group R, n = 43) or 0.9% saline (Group C, n = 43). The primary outcome was the incidence of EA, which was defined as a Riker Sedation–Agitation Scale score > 4. The secondary outcomes included the incidence of severe EA, anesthesia, surgery characteristics, adverse events, mean arterial pressure, and heart rate (at different time points). Results: A total of 86 adult patients completed the study. The incidence of EA was lower in Group R than in Group C (21% vs. 49%, P = 0.007). The incidence of severe EA was also lower in Group R than in Group C (2% vs. 19%, P = 0.035). The maximal Sedation–Agitation Scale score during emergence was lower in Group R 4 [range 4 to 4] than in Group C 5 [range 4 to 6] (P < 0.001). In addition, the incidence of hypertension and grade of cough in Group R were lower than in Group C (P = 0.024). During emergence, the mean arterial pressure and heart rate of group R showed more stability than those in group C. Conclusions: Postoperative intravenous infusion of 0.1 mg/kg remimazolam into adult patients undergoing nasal surgery can reduce the incidence of EA and severe EA, and provide stable hemodynamics. Trial registration: The trial was registered, before patient enrollment, in the Chinese Clinical Trial Registry (www.chictr.org.cn) (clinical trial number: ChiCTR2300075300; Principal Investigator: Gongchen Duan; date of registration: 31 August 2023; https://www.chictr.org.cn/bin/project/edit?pid=203928). [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to evaluate the effect of second-hand smoke (SHS) and third-hand smoke (THS) on the incidence of postoperative emergence agitation (EA) in children. Methods: Six hundred children between the ages of 2-12 were enrolled in this prospective cohort trial. The children were divided into three groups. Group I (Non-smoker; Children whose parents do not smoke and who are not regularly exposed to smoking environments), Group II (Second-hand smoker; Children whose parents smoke in their vicinity, causing them to inhale sidestream or mainstream smoke involuntarily), Group III (Third-hand smoker; Children exposed to pollutants from smoking parents via inhalation, ingestion or dermal contact, despite not directly inhaling sidestream or mainstream smoke). Emergence agitation, postoperative pain, shivering, nausea and vomiting were evaluated in the postanesthesia care unit. Watcha scale was used in the evaluation of emergence agitation. Results: In total, five hundred eighty-six patients completed the study, and the incidence of emergence agitation was higher in Group II (32.7%) and Group III (33.7%) compared to Group I (15.0%) (p < 0.001). The incidence of emergence agitation was dramatically increased in Group II and Group III compared to Group I (32.7% vs. 15.0%; odds ratio (95% confidence interval): 2.74 (1.68-4.48); p = 0.0001, and 33.7% vs. 15.0%; odds ratio (95% confidence interval): 2.87 (1.76-4.70); p < 0.0001, respectively). There was no difference between the groups in terms of postoperative pain, shivering, nausea and vomiting evaluated in the postanesthesia care unit. Conclusions: In conclusion, the results of the present study revealed that SHS and THS significantly increase the incidence of EA in children. Clinical Trial Registration: The trial was registered with the Australian New Zealand Clinical Trial Registry (ACTRN12619001359123). [ABSTRACT FROM AUTHOR]

Background: Patients undergoing oral and nasal surgeries are at high risk of developing emergence agitation. We hypothesised that a single dose of dexmedetomidine would reduce emergence agitation in adults during nasal or oral surgery. METHODS: This prospective, observational study was undertaken in the Department of Anaesthesiology and Critical Care, between January 2022 and December 2023 for a period of 2 years. All the relevant parameters were documented in a structured study proforma. Patients who are to undergo nasal and oral surgeries under GA were enrolled in the study. Anaesthesia was induced with Propofol 1.0-2.0 mg/kg, Fentanyl 1 mcg/kg and Vecuronium 0.1mg/kg for Endotracheal intubation. Anaesthesia was maintained with 50% Air-50% O2 and Desflurane with the MAC of 0.8-1%. These participants were divided into two groups. Group D received Dexmedetomidine @ 0.3mcg/kg/hour 5 minutes before induction and stopped at the time of reversal. Group C received NS @ 20ml/hour 5 minutes before induction and stopped at the time of reversal. Before giving premedication, patients were observed for basal heart rate (HR), basal Non-invasive blood pressure (NIBP) and Pulse oximetry (SpO2). Patients were observed intraoperatively for HR, NIBP, SpO2, etCO2, ECG at regular intervals and postoperatively for agitation by Richmond agitation sedation scale (RASS) and hemodynamic properties will be recorded at preinduction level, induction, intubation, at the time of reversal, at the time of response to verbal command, at the time of extubation and 5 minutes post-extubation. Time to respond to verbal commands and time to extubation after discontinuation of inhalational agents will also be recorded. Results: A total of 100 participants were included in the final analysis with 50(50%) were in group C and remaining 50(50%) were in group D. The mean age in group C was 41.46 ± 12.3 years, it was 41.22 ± 12.01 in group D. Among group C 32 (64%) participants were males, 18 (36%) participants were females. Among group D 26 (52%) participants were males, and 24 (48%) participants were females. The heart rate, mean systolic BP and mean diastolic BP significantly differed between two groups at different periods (P value <0.05). The total time period from the beginning of induction till the time of extubation after discontinuation of inhalational agents in group C was 6.34 ± 0.92 min, it was 8.58 ± 1.53 in group D. The mean time period to respond to verbal commands time after discontinuation of inhalational agents in group C was 7.29 ± 0.73 min, it was 10.58 ± 1.83 in group D. The difference in time periods between the groups was statistically significant (P value <0.001). The median Richmond Agitation Sedation Scale in group C was 0.50(IQR 0 to 1), it was 0(IQR-1 to 0) in the dexmedetomidine group. The difference between the two groups was statistically significant. (P value <0.001). Conclusion: Single dose of dexmedetomidine is associated with better Hemodynamic stability, time to respond to verbal commands, time to extubation after switching off the inhalational agent and lesser emergence agitation in adults. [ABSTRACT FROM AUTHOR]

Emergence agitation (EA) is more commonly observed after thoracic surgeries and can lead to serious complications. This study aimed to evaluate the effectiveness of serratus anterior plane block (SAPB) combined with oxycodone for transitional analgesia in preventing EA after video-assisted thoracoscopic surgery (VATS). A total of 121 adult patients scheduled for VATS under one-lung ventilation anesthesia were enrolled and randomly divided into three groups: preoperative SAPB without opioids for transitional analgesia near the end of the surgery (SAPB + SAL group, n = 39); preoperative SAPB with sufentanil at 0.1 µg/kg for transitional analgesia (SAPB + SF group, n = 42); and preoperative SAPB with oxycodone at 0.1 mg/kg for transitional analgesia (SAPB + OCD group, n = 40). In primary outcomes, the incidences of EA in the SAPB + SAL, SAPB + SF, and SAPB + OCD groups were 38.5%, 28.6%, and 7.5% respectively. There was a statistically significant difference in EA incidence between the SAPB + OCD and SAPB + SF groups (P = 0.0136). In secondary outcomes, compared to the SAPB + SF group, the SAPB + OCD group experienced shorter tracheal extubation time [15(9, 25) min vs. 21.5(14.5, 32.5) min; P = 0.0473] and PACU stay [67.5(55.0, 85.0) min vs. 87.5(70.0, 110.0) min; P = 0.0026]; lower NRS scores at 15 min and 2 h post-extubation (P < 0.01), and higher Quality of Recovery-15 (QoR-15) scores post-surgery [113(98, 123) vs. 102(88, 112); P = 0.0122]. Our results suggest SAPB combined with oxycodone for transitional analgesia, compared with sufentanil, is more effective in preventing EA after VATS and conductive to rapid recovery postoperatively. Trial registration: Chinese Clinical Trial Registry, identifier: ChiCTR2300077473, Date: 09/11/2023. [ABSTRACT FROM AUTHOR]

Background: Intravenous dexmedetomidine could reduce the incidence of postoperative agitation. However, it could also delay discharge from the hospital and increase the incidence of hypotension. This study aimed to evaluate the effect of caudal dexmedetomidine on the emergence of agitation in pediatrics after infra-umbilical surgeries. Methods: This Prospective randomized controlled clinical trial included 104 pediatric patients with age group from 2 to 6 years undergoing elective infra umbilical surgeries, categorized into two equal groups (52 each): Control group (C): patients who received caudal block using 2 mg/kg of 0.25% bupivacaine diluted in saline. Dexmedetomidine group (D): patients who received caudal block using 2 mg/kg of 0.25% bupivacaine and 0.5 µg/kg dexmedetomidine. Incidence and severity of emergence Agitation (EA), hemodynamics, sedation level, duration of the caudal block, and adverse events were evaluated. Results: The control group had a higher incidence of agitation than the dexmedetomidine group (p<0.05), denoting that caudal dexmedetomidine effectively decreased the incidence of emergence agitation. The Dexmedetomidine group had a longer post-anesthesia care unit (PACU) stay duration than the Control group (P=<0.001). The control group had a significantly higher FLACC Pain Score than the dexmedetomidine group during the next 6-24 hours at the ward (p=<0.001). Conclusion: The addition of 0.5 µg/kg dexmedetomidine 0.5 to the local anesthetic 2 mg/kg of 0.25% bupivacaine in a single-shot caudal block could decrease the incidence of emergence agitation, prolong the duration of the block, and postoperative analgesia and also reduce postoperative analgesic requirements without significant hemodynamic instability or postoperative complications. Therefore, dexmedetomidine may be the drug of choice to be given as an additive to local anesthetics in the caudal block. [ABSTRACT FROM AUTHOR]

To determine if postanesthesia forced–air warming as a nonpharmacologic intervention for emergence delirium (ED)/emergence agitation (EA) decreased the incidence and severity of ED in children aged 18 months to 6 years old. Prospective nonrandomized controlled trial. Participants included children aged 18 months to 6 years old receiving general anesthesia within a radiation oncology setting. Status of ED/EA was based on the participants' Pediatric Anesthesia Emergence Delirium (PAED) scale score (two consecutive scores greater than 10 out of 20) or inconsolable agitation behaviors post computed tomography simulation (day 0). Interrater reliability was conducted among the center's perianesthesia care nurses. Participants who scored positive for ED/EA received a forced-air warming blanket for the remainder of treatment with data collection 1 to 14 days postanesthesia. Non-ED/EA participants were followed for 14 days and provided forced-air warming if ED/EA occurred. Data consisted of daily PAED scores and self- or parent-report on the anxiety scale. If the participants received forced-air warming, nurses' clinical observations and parent satisfaction surveys were collected 3 times during the 14-day study period. A total of 59 participants completed the study (mean age 3.43 years; 60% male; 63% non-Hispanic White); 16 were identified with ED or EA (mean age 3.56 years; 50% male; 69% non-Hispanic White) with an incidence rate of 28%. For the 16 participants with ED/EA, the primary diagnosis consisted of solid tumors and an American Society of Anesthesia Classification III to IV. Prior to the forced-air warming intervention, all 16 participants exhibited inconsolable ED/EA behaviors, including 8 who had PAED scores greater than 10. ED/EA behaviors expressed included inconsolability, confusion, thrashing, and combativeness. Within the 14-day period, 3 participants received forced-air warming on day 1, while the other 13 received an average of 4.23 days of treatment (range 1 to 11 days; mode 1 day; median 4 days). Comparison of PAED scores pre (mean 4.4) and post (mean 1.8) indicated that the use of forced-air warming was statistically significant (P =.001). ED/EA behaviors and PAED scores after the forced-air warming period decreased in all but one participant. Some agitation behaviors were not captured within the PAED score. Forced-air warming impacted PAED scores and agitation behaviors for studied participants, offering a safe, nonpharmacological nursing intervention that may be an effective tool for helping to manage this baffling condition. [ABSTRACT FROM AUTHOR]

Emergence agitation (EA) is a frequent complication during emergence. The researchers aimed to investigate whether discharged pediatric patients from the postanesthesia care unit (PACU) to wards under sedated status could reduce the incidence of EA. Prospective randomized controlled study. This study was conducted in 4 to 6 year old patients who had undergone strabismus surgeries. There were 100 patients randomly assigned to a sedated group who were discharged from PACU to the ward under a sedated state and regained consciousness accompanied with their parents (Group P, n = 50) and the control group who were fully awake when discharged (Group C, n = 50). The primary outcome was the incidence of EA. The secondary outcomes included rescue measure, discharge time, hemodynamic parameters at the point of discharge, 1 and 2 hours after extubation, and the parental satisfaction score. The incidence of EA in Group P was significantly reduced compared to Group C (P =.023). The number of patients who needed rescue measures was higher in Group C than in Group P (P =.041). The PACU discharge time in Group P was significantly shorter than in Group C (P <.001). The heart rate of the pediatric patients in Group P was significantly lower than in Group C at the point of discharge from PACU to the ward (P =.003), while the oxygen saturation (SpO 2) and the mean arterial blood pressure were comparable between the two groups (P >.05). Pediatric patients discharged to their parents under sedated status could reduce the incidence of EA undergoing strabismus surgery. [ABSTRACT FROM AUTHOR]

Emergence agitation (EA) after (adeno)tonsillectomy (AT) surgery impairs recovery in children. Adequate analgesia plays a crucial role in reducing EA incidence. This study investigated whether hydromorphone infusion (30 μg/kg) during anesthesia induction could reduce EA following AT surgery for obstructive sleep apnea in children.

Dan Wang,1,2,&ast; Jing-Hui Hu,1,2,&ast; Hai-Jing Shi,1,2,&ast; Min-Yuan Zhuang,1,2 Wei Dou,1,2 Fu-Hai Ji,1,2 Ke Peng1,2 1Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 2Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ke Peng, Department of Anesthesiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, People’s Republic of China, Tel +86-512-67780055, Email pengke0422@163.comBackground: Emergence agitation (EA) is a state of psychomotor hyperactivity following general anesthesia and is associated with postoperative complications. Patients undergoing ear, nose, and throat (ENT) surgery are at a high risk for EA. We aim to assess whether preoperative dexmedetomidine nasal spray reduces the occurrence of EA for patients undergoing ENT surgery.Methods: This is a protocol for a randomized, double-blind, controlled trial that will include 160 adults scheduled for ENT surgery. Patients will be randomly assigned, in a 1:1 ratio, to receive dexmedetomidine nasal spray (100 μg) or a same volume of normal saline approximately 30 min before general anesthesia induction. The primary endpoint is the incidence of EA, defined as a Riker sedation agitation scale (RSAS) score ≥ 5 from discontinuation of sevoflurane until 5 min after tracheal extubation. Secondary endpoints include (1) the maximal RSAS score during emergence; (2) the incidence of agitation in the postoperative care unit (PACU); (3) pain at rest and while coughing in the PACU and at 24 h postoperatively; (4) postoperative sleep disturbance on the first night after surgery; (5) anxiety within 24 h postoperatively; and (6) postoperative delirium during the first 24 h after surgery. All analyses will be performed on a modified intention-to-treat basis. For the primary endpoint, subgroup analysis will be conducted on sex, age, and type of surgery.Discussion: We expect that preoperative dexmedetomidine nasal spray would reduce the incidence of EA after ENT surgery. Our results offer clinical evidence for improving anesthetic care for patients undergoing ENT surgery.Trial Registration: Chinese Clinical Trial Registry (Identifier: ChiCTR2400086731).Keywords: emergence agitation, dexmedetomidine, intranasal administration, ENT surgery

Emergence delirium remains a clinically significant issue, often leading to short-term distress among pediatric patients, parents, and staff, and potentially resulting in postoperative maladaptive behaviors persisting for weeks to months. Although several diagnostic tools are available, the Pediatric Anesthesia Emergence Delirium Scale is most often utilized. Many risk factors contributing to the likelihood of a pediatric patient developing emergence delirium have been identified; however, its accurate prediction remains challenging. Recently, intraoperative electroencephalographic monitoring has been used to improve the prediction of emergence delirium. Similarly, it may also prevent emergence delirium if the anesthesiologist ensures that the at-risk patient rouses only after the onset of appropriate electroencephalogram patterns, thus indicating a change to natural sleep. Prediction of at-risk patients is crucial; preventing emergence delirium may begin early during patient preparation by using non-pharmacological methods (i.e., the ADVANCE program). Intraoperative electroencephalographic monitoring can predict emergence delirium. This review also discusses a range of pharmacological treatment options which may assist the anesthesiologist in preventing emergence delirium among at-risk patients. [ABSTRACT FROM AUTHOR]

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Yan Li, Qi Li, Guangchao Zhao, Haopeng Zhang, Haixing Zhong, Yi Zeng Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of ChinaCorrespondence: Yi Zeng; Haixing Zhong, Department of Anesthesia and Perioperative Medicine, Xijing Hospital, the Fourth Military Medical University, Xi’an, 710000, People’s Republic of China, Tel +8613991267646 ; +8613991946615, Email zengyi1014@163.com; haixing.zhong@139.comBackground: To investigate the effects of nalbuphine on emergency agitation (EA), which affects up to 80% of the children following otolaryngology procedures, in children undergoing cochlear implantation.Methods: A prospective double-blinded randomized controlled clinical trial was conducted between November 2020 and October 2022. Eligible children, aged 6 months to 3 years old, were randomly assigned to either 0.1 mg/kg, 0.15 mg/kg, 0.2 mg/kg nalbuphine or 0.9% saline groups. EA was defined by the Pediatric Anesthesia Emergence Delirium (PAED) score ≥ 10. Extubation time, post-anesthesia care unit (PACU) length of stay, severe EA (PAED ≥ 15), peak PAED score, the Faces, Legs, Activity, Cry, and Consolability (FLACC) scale, Ramsay sedation score, and adverse events were also recorded.Results: A total of 104 children were enrolled, with 26 children in each group. Nalbuphine significantly reduced the EA occurrence from 73.1% in the saline group to 38.5%, 30.8%, and 26.9% in the 0.1 mg/kg, 0.15 mg/kg, and 0.2 mg/kg nalbuphine groups, respectively (P < 0.001), without affecting the extubation time and PACU length of stay. More children (34.6%) in the 0.9% saline group experienced severe EA. Higher dose nalbuphine (0.15 mg/kg, 0.2 mg/kg) showed lower peak PAED score, better analgesia and sedation effect compared with 0.1 mg/kg nalbuphine and saline groups. However, 0.2mg/kg nalbuphine caused undesired over-sedation in two (7.7%) children. No other adverse events were reported.Conclusion: Young children undergoing cochlear implantation surgery were at a high risk of EA and postoperative pain, while 0.2 mg/kg nalbuphine might be an ideal candidate for EA and pain prevention when used under close monitoring.Trial Registration: ChiCTR2000040407.Keywords: emergence agitation, nalbuphine, cochlear implantation, postoperative pain

Abstract Background Emergence agitation is a transient confusional state of a child associated with consciousness from general anaesthesia, commonly occurs in the postoperative setting which delays their recovery and exposes them to traumas. The main objective of the current study was to investigate the magnitude of emergence agitation, its interventions and associated factors among paediatric surgical patients at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods Hospital based cross-sectional study with prospective follow-up framework was conducted on a paediatric surgical patients aged 2-14 years who underwent surgery under general anaesthesia between June 1 - October 30 2022. Stratified sampling method followed by simple random sampling technique was employed to reach study participants. Magnitude of emergence agitation and its interventions done at post-anaesthetic care units were recorded. Data analysis was carried out using a descriptive statistics method and the results were summarized using tables and diagrams. Bivariate analysis was done to identify causal relationship and multivariable analysis to assess the confounding effects of factors associated with emergence agitation. A p-value of less than 0.05 was considered statistically significant factor. Results A total of 150 participants were included in the current study, where 107 (71.3%) were male and 97 (64.7%) were preschool aged. About 81 (54%) of care givers were female and majority of them have completed primary school. The mean (standard deviation) age of the participants was 6.4 (3.57) years. Around 42.7% of them developed emergence agitation with an average duration of 8.39 ± 4.45 minutes. Factors such as propofol administration at the end of procedure (OR of 0.104 with 95% CI [0.035, 0305]), Ear, nose, throat surgery and oral maxillofacial surgery (OR of 2.341 with 95% CI [1.051, 5.211]) and arrival of patient to recovery awake (OR of 0.456 95% CI [0.209, 0.994]) showed statistically significant association with emergence agitation. Conclusion Almost half of the study participants experienced emergence agitation which is high magnitude. Ear, nose, throat surgery and oral maxillofacial surgeries were predictive factors of emergence agitation while propofol administration at the end of procedure and arrival of patient to recovery awake significantly decreased risk of emergence agitation. Therefore, anaesthesia personnel should have essential skills and knowledge to effectively care for children perioperatively including to minimize and treat emergence agitation.

Introduction: Emergence agitation (EA) is a problem that often occurs in pediatric patients during recovery from anesthesia. The cause of EA remained unclear, but the combination of etiologies increases the risk of postoperative agitation. The researchers use various drugs such as ketamine, midazolam, and dexmedetomidine to prevent and treat EA. Objective: This review aims to determine the effectiveness of dexmedetomidine, midazolam, and ketamine in preventing emergence agitation in pediatric patients undergoing surgery under general anesthesia. Method: This literature review is a narrative review that looks at the outcomes of randomized controlled trials (RCT) studies that tested how well dexmedetomidine, midazolam, and ketamine worked at keeping pediatric patients from becoming agitated during emergence. Literature was collected through Google Scholar and PubMed using the keywords Pediatric, Children, Dexmedetomidine, Ketamine, Midazolam, Emergence Agitation, Emergence Delirium, Postoperative Agitation, and Postoperative Delirium and published within the last ten years (2011–2021) in English or Indonesian. The researchers excluded articles that were not available in full, as well as literature reviews. Results: Based on the specified database and keywords identified, there were 695 articles. This literature study included thirteen articles that met the inclusion criteria. Ten articles examined the effectiveness of dexmedetomidine, four reviewed the effectiveness of midazolam, and three examined the effectiveness of ketamine. Conclusion: According to the ten reviewed articles, administering dexmedetomidine or ketamine reduced the incidence of emergence agitation in children. However, the administration of midazolam yielded inconsistent results. To evaluate the optimal dosage, route, and timing of dexmedetomidine, midazolam, and ketamine in preventing EA, further studies are necessary.

Background: Emergence agitation is a transient confusional state of a child associated with consciousness from general anaesthesia, commonly occurs in the postoperative setting which delays their recovery and exposes them to traumas. The main objective of the current study was to investigate the magnitude of emergence agitation, its interventions and associated factors among paediatric surgical patients at Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. Methods: Hospital based cross-sectional study with prospective follow-up framework was conducted on a paediatric surgical patients aged 2-14 years who underwent surgery under general anaesthesia between June 1 - October 30 2022. Stratified sampling method followed by simple random sampling technique was employed to reach study participants. Magnitude of emergence agitation and its interventions done at post-anaesthetic care units were recorded. Data analysis was carried out using a descriptive statistics method and the results were summarized using tables and diagrams. Bivariate analysis was done to identify causal relationship and multivariable analysis to assess the confounding effects of factors associated with emergence agitation. A p-value of less than 0.05 was considered statistically significant factor. Results: A total of 150 participants were included in the current study, where 107 (71.3%) were male and 97 (64.7%) were preschool aged. About 81 (54%) of care givers were female and majority of them have completed primary school. The mean (standard deviation) age of the participants was 6.4 (3.57) years. Around 42.7% of them developed emergence agitation with an average duration of 8.39 ± 4.45 minutes. Factors such as propofol administration at the end of procedure (OR of 0.104 with 95% CI [0.035, 0305]), Ear, nose, throat surgery and oral maxillofacial surgery (OR of 2.341 with 95% CI [1.051, 5.211]) and arrival of patient to recovery awake (OR of 0.456 95% CI [0.209, 0.994]) showed statistically significant association with emergence agitation. Conclusion: Almost half of the study participants experienced emergence agitation which is high magnitude. Ear, nose, throat surgery and oral maxillofacial surgeries were predictive factors of emergence agitation while propofol administration at the end of procedure and arrival of patient to recovery awake significantly decreased risk of emergence agitation. Therefore, anaesthesia personnel should have essential skills and knowledge to effectively care for children perioperatively including to minimize and treat emergence agitation. [ABSTRACT FROM AUTHOR]

Background: The most often used anesthetics for pediatric surgery are propofol and sevoflurane. These general anesthetics' main side effects are postoperative discomfort, nausea and vomiting, and agitation during the recovery room. The safety of sevoflurane and propofol in pediatric surgery has been compared in numerous clinical investigations, although the findings were unclear. So, this study aimed to compare effective outpatient surgery in pediatrics with reducing emergence agitation, delirium, and anesthesia complications by comparing effects Propofol or sevoflurane on recovery outcome for outpatient surgery in pediatrics. Methods: This Randomized, double-blind clinical study was conducted on 40 cases planned for outpatient surgery in pediatrics attended the anesthesia, intensive care, and pain management department in Zagazig University Hospitals throughout six months started from March 2023 to September 2023. All Cases were chosen from Zagazig University Hospitals' outpatient clinics who were willing to have an elective outpatient surgery. Results: There was significant shorter extubation time and discharge time in the Propofol group compared to Sevoflurane group. Otherwise there were no significant differences between groups regards other parameters. There was significantly lower heart rate in the Propofol group from basal reading until 45 minute of operation time compared to Sevoflurane group. Conclusions: When compared to sevoflurane anesthesia, children who underwent propofol anesthesia had lower chances of emerging anxiety, postoperative nausea and vomiting, and postoperative discomfort. In comparison to sevoflurane-based anesthetic, the propofol regimen provided a more relaxing recovery and reduced postoperative respiratory problems in infants undergoing outpatient surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Post-anesthetic emergence agitation is common after general anesthesia and may cause adverse consequences, such as injury as well as respiratory and circulatory complications. Emergence agitation after general anesthesia occurs more frequently in nasal surgery than in other surgical procedures. This study aimed to assess the occurrence of emergence agitation in patients undergoing nasal surgery who were extubated under deep anesthesia or when fully awake. Methods A total of 202 patients (18–60 years, American Society of Anesthesiologists classification: I–II) undergoing nasal surgery under general anesthesia were randomized 1:1 into two groups: a deep extubation group (group D) and an awake extubation group (group A). The primary outcome was the incidence of emergence agitation. The secondary outcomes included number of emergence agitations, sedation score, vital signs, and incidence of adverse events. Results The incidence of emergence agitation was lower in group D than in group A (34.7% vs. 72.8%; p

Abstract Introduction Surgeries conducted at night can impact patients’ prognosis, and the mechanism may be related to circadian rhythm, which influence normal physiological functions and pathophysiological changes. Melatonin is primarily a circadian hormone with hypnotic and chronobiotic effects, thereby affecting disease outcomes through influencing the expression of inflammatory factors and biochemical metabolism. This study aims to observe the effects of circadian rhythms on emergence agitation and early postoperative delirium of older individuals undergoing thoracoscopic lung cancer surgery and explore the possible regulatory role of melatonin. Methods This prospective, observational, cohort study will involve 240 patients. Patients will be routinely divided into three groups based on the time of the surgery: T1 (8:00–14:00), T2 (14:00–20:00) and T3 group (20:00–08:00). The primary outcome will be the incidence of emergence agitation assessed via the Richmond Agitation and Sedation Scale (RASS) in the post-anesthesia care unit (PACU). Secondary outcomes will include the incidence of early postoperative delirium assessed via the Confusion Assessment Method (CAM) on postoperative day 1, pain status assessed via the numerical rating scale (NRS) in the PACU, sleep quality on postoperative day 1 and changes in perioperative plasma melatonin, clock genes and inflammatory factor levels. Postoperative surgical complications, intensive care unit admission and hospital length of stay will also be evaluated. Discussion This paper describes a protocol for investigating the effects of circadian rhythms on emergence agitation and early postoperative delirium of older individuals undergoing thoracoscopic lung cancer surgery, as well as exploring the potential regulatory role of melatonin. By elucidating the mechanism by which circadian rhythms impact postoperative recovery, we aim to develop a new approach for achieving rapid recovery during perioperative period. Trial registration The study was registered at the Chinese Clinical Trials Registry (ChiCTR2000040252) on November 26, 2020, and refreshed on September 4, 2022.

Emergence agitation (EA) is a behavioural disturbance encountered during the recovery phase of patients following general anaesthesia. It is characterised by restlessness, involuntary limb movements, and drainage tube withdrawal and may significantly harm patients and medical staff. The mechanism of EA has not been fully understood and is still a challenging subject for researchers.

Background: Post-anesthetic emergence agitation is common after general anesthesia and may cause adverse consequences, such as injury as well as respiratory and circulatory complications. Emergence agitation after general anesthesia occurs more frequently in nasal surgery than in other surgical procedures. This study aimed to assess the occurrence of emergence agitation in patients undergoing nasal surgery who were extubated under deep anesthesia or when fully awake. Methods: A total of 202 patients (18–60 years, American Society of Anesthesiologists classification: I–II) undergoing nasal surgery under general anesthesia were randomized 1:1 into two groups: a deep extubation group (group D) and an awake extubation group (group A). The primary outcome was the incidence of emergence agitation. The secondary outcomes included number of emergence agitations, sedation score, vital signs, and incidence of adverse events. Results: The incidence of emergence agitation was lower in group D than in group A (34.7% vs. 72.8%; p < 0.001). Compared to group A, patients in group D had lower Richmond Agitation-Sedation Scale scores, higher Ramsay sedation scores, fewer agitation episodes, and lower mean arterial pressure when extubated and 30 min after surgery, whereas these indicators did not differ 90 min after surgery. There was no difference in the incidence of adverse events between the two groups. Conclusions: Extubation under deep anesthesia can significantly reduce emergence agitation after nasal surgery under general anesthesia without increasing the incidence of adverse events. Trial registration: Registered in Clinicaltrials.gov (NCT04844333) on 14/04/2021. [ABSTRACT FROM AUTHOR]

Objective: To analyze the effect of preoperative nasal drip of dexmedetomidine combined with fascia iliaca compartment block (FICB) on perioperative hemodynamics, anesthesia quality and emergence agitation in elderly patients undergoing hip fracture surgery. Methods: Elderly patients who underwent hip fracture surgery in No.909 Hospital of the Joint Logistic Support Force of the Chinese People’s Liberation Army were selected as the research subjects and randomly divided into control group (75 cases, FICB) and observation group (75 cases, preoperative nasal drip of dexmedetomidine combined with FICB) . Perioperative hemodynamics, anesthesia quality, emergence agitation and adverse reactions were compared between groups. Results: The two groups had similar mean arterial pressure (MAP) and heart rate (HR) when entering the waiting room (P＞0.05) . The observation group had significantly lower MAP and HR than the control group when leaving the waiting room, immediately after transfer from the bed, when the body position was successfully placed and at the end of lumbar anesthesia puncture (P＜0.05) . The onset time of FICB in the observation group was significantly shorter than that in the control group (P＜0.05) . The NRS scores of the observation group at 1 h, 2 h, 4 h and 6 h after surgery were significantly lower than those of the control group (P＜0.05) . The Riker SAS scores of the observation group at 10 min, 20 min and 60 min after extubation were significantly lower than those of the control group (P＜0.05) . The incidences of adverse reactions in the two groups were close (P＞0.05) . Conclusion: Preoperative nasal drip of dexmedetomidine combined with FICB is beneficial for maintaining stable hemodynamics, shortening the onset time of FICB and improving the analgesic effect in patients undergoing hip fracture surgery. Meanwhile, it can significantly reduce emergence agitation, without increasing adverse reactions. [ABSTRACT FROM AUTHOR]

Background: Reducing a child's level of anxiety before magnetic resonance imaging (MRI) procedures allows for better behavioral outcomes. The aim of this retrospective study was to evaluate anxiolytic efficacy of Midazolam/γ-cyclodextrin oral formulation. Methods: We retrospectively reviewed 100 medical charts of children who, between 1 February and 31 July 2022, underwent MRI under general anesthesia with or without premedication with midazolam/γ-cyclodextrin. Primary outcome was comparison of behavior to facemask positioning, while secondary endpoints were degree of drugs acceptance, anxiolytic effect evaluation, child's behavior on separation, and sevoflurane need. Results: Facemask positioning was accepted by 58% of the midazolam/γ-cyclodextrin group compared to 22% of children in the control group. The rate of acceptance was >90%. At the moment of separation from parent, none of the premedicated children needed to be restrained compared to 18% in the control group. A lower percentage of sevoflurane was needed for eye-closure at induction of anesthesia and for anesthesia maintenance. At emergence from anesthesia, 46% of children in the premedicated group compared to 66% of children in the control group showed transient agitation. Conclusions: Midazolam/γ-cyclodextrin showed a good profile of acceptance, satisfactory anxiolytic properties, and reduced need for anesthetics when administered to children before MRI under general anesthesia. [ABSTRACT FROM AUTHOR]

The effects of emergence agitation (EA), also known as emergence delirium, can be clinically substantial. EA's mechanism is yet unknown. Age, male sex, the type of surgery, an emergency procedure, the use of inhalational anesthetics with low bloodgas partition coefficients, a lengthy procedure, anticholinergics, premedication with benzodiazepines, postoperative pain, and the presence of invasive devices are among the proposed risk factors for EA. There are numerous tools available for evaluating EA. However, there are no established best practices for clinical research. Preoperative instruction for surgery, parent-present induction, localized analgesia, multimodal analgesia, propofol, Nefopam, N-methyl-D-aspartate receptor antagonists, and opioid agonists, and total intravenous anesthesia may all aid in preventing EA. However, it might be challenging to recognize high-risk patients and implement preventative strategies in varied therapeutic settings. The techniques of studies and the patients evaluated affect the risk variables and outcomes of preventative interventions. In this review, we cover significant findings from EA research as well as prospective research directions. [ABSTRACT FROM AUTHOR]

Background: Emergence agitation is a complex syndrome of altered consciousness after emergence from anesthesia. It can result in injury to patients and staff and is associated with other postoperative complications. Sevoflurane has been associated with emergence agitation, potentially due to low tissue solubility and therefore speed of emergence. Prior meta‐analyses comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics did not demonstrate a statistically significant difference. Given the publication of additional relevant studies not included in prior meta‐analyses as well as improved diagnosis of emergence agitation, we aim to perform an updated, comprehensive meta‐analysis comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics in children. Methods: We conducted an updated systematic review and meta‐analysis of clinical trials comparing sevoflurane to isoflurane in children <18 years of age, reporting emergence agitation as an outcome, published before July 2023 using databases and registers. Our primary outcome was the incidence of emergence agitation. Secondary outcomes were time to extubation, awakening time, and length of stay in the postanesthetic care unit. We assessed the risk of bias using the Cochrane Risk of Bias tool version 2. We pooled the effect size for the outcomes using the fixed effects model if we had low heterogeneity, otherwise, we used a random‐effects model. Results: Eight randomized controlled trials (523 children) were included in the final analysis. The incidence of emergence agitation after isoflurane was significantly lower compared to sevoflurane (risk ratio: 0.62 (95% CI: [0.46–0.83]; I2 = 40.01%, p <.001)). Time to extubation, awakening times, and postanesthetic care unit duration were not significantly different. The protective effect of isoflurane compared to sevoflurane remained significant in subgroups of patients who received premedication or intraoperative systemic analgesics (risk ratios: (0.48 [0.28–0.82]; I2 = 60.78%, p =.01), (0.52 [0.37–0.75]; I2 = 0.00%, p <.001), respectively). Conclusion: The risk of emergence agitation in children after maintenance anesthesia with sevoflurane is significantly greater than with isoflurane; we did not find evidence of prolonged emergence or postanesthetic length of stay. When possible, isoflurane should be considered for maintenance anesthesia over sevoflurane in patients at high risk of emergence agitation. [ABSTRACT FROM AUTHOR]

Background and objective: Emergence agitation is a common phenomenon in children recovering from general anesthesia. An emergence agitation reaction increases the risk of injuring the surgical repair, the patient, and the caregivers. Thus, we aim to explore the efficacy of melatonin premedication on emergence agitation in children undergoing herniorrhaphy surgeries. Patients and methods: A randomized prospective triple-blinded trial was conducted on 117 children with herniorrhaphy surgeries conducted at the Anesthesia, ICU, and Pain Management Department, Menoufia University hospitals from April 2022 to July 2023. Results: Yale preoperative scale at the start did not significantly differ among the studied groups (P>0.05). However, the Yale preoperative scale at 1 was significantly higher in group 1 with a mean of 10.2±1.9 than in group 2 (9.5±1.4) and group 3 (5.9±1.4) (P<0.001). The agitation score at 5 h was significantly higher among group 1 with a mean of 2.77±0.67 than group 2 (2.56±0.64) and group 3 (2.03 ±0.96) (P<0.001). Also, agitation scores at 10 and 15 h were significantly higher in group 1 (3.36±0.63, 4.2±0.66) than in group 2 (3.2±0.66, 3.79±0.73) and group 3 (1.74±0.88, 2.03±1.04), respectively (P<0.001). Conclusion: Melatonin premedication decreased the agitation scale postoperatively. The decrease was significantly higher in high doses in preventing emergence agitation in children. High-dose melatonin compared with low dose might have a significant effect in preventing emergence agitation. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of postoperative emergence delirium in paediatric patients (pedED) following desflurane anaesthesia is considerably high at 50–80%. Although several pharmacological prophylactic strategies have been introduced to reduce the risk of pedED, conclusive evidence about the superiority of these individual regimens is lacking. The aim of the current study was to assess the potential prophylactic effect and safety of individual pharmacotherapies in the prevention of pedED following desflurane anaesthesia. Methods: This frequentist model network meta-analysis (NMA) of randomized controlled trials (RCTs) included peer-reviewed RCTs of either placebo-controlled or active-controlled design in paediatric patients under desflurane anaesthesia. Results: Seven studies comprising 573 participants were included. Overall, the ketamine + propofol administration [odds ratio (OR) = 0.05, 95% confidence intervals (95%CIs) 0.01–0.33], dexmedetomidine alone (OR = 0.13, 95%CIs 0.05–0.31), and propofol administration (OR = 0.30, 95%CIs 0.10–0.91) were associated with a significantly lower incidence of pedED than the placebo/control groups. In addition, only gabapentin and dexmedetomidine were associated with a significantly higher improvement in the severity of emergence delirium than the placebo/control groups. Finally, the ketamine + propofol administration was associated with the lowest incidence of pedED, whereas gabapentin was associated with the lowest severity of pedED among all of the pharmacologic interventions studied. Conclusions: The current NMA showed that ketamine + propofol administration was associated with the lowest incidence of pedED among all of the pharmacologic interventions studied. Future large-scale trials to more fully elucidate the comparative benefits of different combination regimens are warranted. Trial registration: PROSPERO CRD42021285200. [ABSTRACT FROM AUTHOR]

Introduction: Surgeries conducted at night can impact patients' prognosis, and the mechanism may be related to circadian rhythm, which influence normal physiological functions and pathophysiological changes. Melatonin is primarily a circadian hormone with hypnotic and chronobiotic effects, thereby affecting disease outcomes through influencing the expression of inflammatory factors and biochemical metabolism. This study aims to observe the effects of circadian rhythms on emergence agitation and early postoperative delirium of older individuals undergoing thoracoscopic lung cancer surgery and explore the possible regulatory role of melatonin. Methods: This prospective, observational, cohort study will involve 240 patients. Patients will be routinely divided into three groups based on the time of the surgery: T1 (8:00–14:00), T2 (14:00–20:00) and T3 group (20:00–08:00). The primary outcome will be the incidence of emergence agitation assessed via the Richmond Agitation and Sedation Scale (RASS) in the post-anesthesia care unit (PACU). Secondary outcomes will include the incidence of early postoperative delirium assessed via the Confusion Assessment Method (CAM) on postoperative day 1, pain status assessed via the numerical rating scale (NRS) in the PACU, sleep quality on postoperative day 1 and changes in perioperative plasma melatonin, clock genes and inflammatory factor levels. Postoperative surgical complications, intensive care unit admission and hospital length of stay will also be evaluated. Discussion: This paper describes a protocol for investigating the effects of circadian rhythms on emergence agitation and early postoperative delirium of older individuals undergoing thoracoscopic lung cancer surgery, as well as exploring the potential regulatory role of melatonin. By elucidating the mechanism by which circadian rhythms impact postoperative recovery, we aim to develop a new approach for achieving rapid recovery during perioperative period. Trial registration: The study was registered at the Chinese Clinical Trials Registry (ChiCTR2000040252) on November 26, 2020, and refreshed on September 4, 2022. [ABSTRACT FROM AUTHOR]

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Jun Li,1,2 Hongrui Zhu,2 Yu Wang,3 Jiaqi Chen,2 Keqiang He,2 Sheng Wang2 1Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People’s Republic of China; 2Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China; 3Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Soochow, People’s Republic of ChinaCorrespondence: Sheng Wang, Department of Anesthesiology, The First Affiliated Hospital of USTC, No. 17, Lujiang Road, Luyang District, Hefei, Anhui, People’s Republic of China, Email iamsheng2020@ustc.edu.cnBackground: Emergence agitation (EA) is one of the most common complications in clinical general anesthesia during recovery in adults. Remifentanil and propofol can reduce the incidence of EA, but with no randomized controlled trial to evaluate their effectiveness for treating EA. This study aims to compare the effectiveness of remifentanil and propofol for treating EA following general anesthesia.Patients and methods: Among 152 randomized patients with a mean of 49.5 years, and 99 (65.1%) of them being male, 149 were divided into two groups for subsequent analysis. The remifentanil group (Group R, n = 74) received a 0.5μg kg– 1 remifentanil infusion followed by a 0.05μg kg– 1 min– 1 infusion until 15 minutes, after the onset of agitation. The propofol group (Group P, n = 75) received a 1mg kg– 1 propofol infusion once agitation occurred. Emergence agitation was assessed using the Riker Sedation Agitation Score, with a score of ≥ 5 defining emergence agitation. During the post–anesthesia care unit (PACU), the recurrence of emergence agitation, time to extubation, and discharge from PACU were evaluated.Results: The incidence of reoccurring emergence agitation was lower in Group R (29.7%) compared with Group P (49.3%), with an odds ratio of 0.44 (95% CI 0.22– 0.85; P=0.014). The time to extubation was shorter in Group R (mean 12min, range 8– 15 min) compared with Group P (mean 17min, range 13– 21 min) (P< 0.001), as was the time discharge from the PACU (mean 30.5 min, range 25– 40 min) vs Group P (mean 37.5 min, range 31– 50 min) (P=0.001).Conclusion: Treatment of emergence agitation in adults with remifentanil infusion is more effective than propofol, with a shorter time to extubation and discharge from PACU.Keywords: anesthesia, emergence agitation, remifentanil, propofol

Abstract Background and aim Emergence agitation (EA) after general anesthesia is common in patients with post-traumatic stress disorder (PTSD). Due to the recent worldwide events such as the Covid-19 pandemic and wars, PTSD is not rare. Accordingly, a reliable, cost-effective anesthetic protocol to lower the incidence of EA is crucial. Therefore, we aimed to compare three different interventions for avoiding EA in PTSD patients undergoing gynecological laparoscopic surgery. Participants were divided into four groups: 1: performing pre-operative relaxation techniques (deep breathing exercise and progressive muscle relaxation [PMR]); 2: administrating intra-operative Ketamine; 3: applying both previously mentioned strategies and 4 as controls. Methods This study was carried out on 144 adult women scheduled for gynecological laparoscopy, randomly allocated into four groups: three intervention groups and a control group (36 each). Women aged 18-45 years old, with a diagnosis of PTSD were included in the study. Patients with a positive history of major neurological, cardiovascular, metabolic, respiratory, or renal disease were excluded. Any patient who reported the use of psychiatric drugs were also excluded from the study. Data was analyzed using IBM SPSS Statistics software version 26. Kolmogorov- Smirnov was used to verify the normality of the distribution of variables. Odds ratio was calculated to clarify the strength and direction of the association between intervention groups and control. Data was deemed significant at a p-value ≤0.05. Results Heart rate (HR) and Mean Arterial Blood Pressure (MABP) intra-operative and post-operative till 24 hours were significantly lower in groups 1, 2, and 3 compared to group 4 (p

ABSTRACTBackground Postoperative agitation is characterized by increased recovery time, irritability, and disorientation. This study hypothesized that adding nalbuphine to caudal bupivacaine could improve postoperative emergence agitation (EA). Methods Eighty children (2-12 years and ASA I-II) undergoing sub-umbilical abdominal surgeries were randomly allocated into two equal groups. Group-B received caudal bupivacaine 0.125 of 1 ml/kg plus 2 ml normal saline, whereas Group-N received caudal bupivacaine 0.125 of 1 ml/kg plus 0.2 mg/kg nalbuphine diluted in 2ml normal saline. We evaluated postoperative EA according to the pediatric anesthesia emergence delirium scale (PAED) on admission to the PACU and every 30 minutes for two hours postoperatively. Postoperative pain, sedation, rescue analgesia complications, and parents’ satisfaction were also recorded. Results No statistically significant difference between both groups regarding the postoperative PAED scale at different times (p > 0.05), but inside each group, there was a significant decrease PAED scale at different times of assessment (p < 0.001) as compared to baseline data. Group-N had significantly better results concerning postoperative sedation and analgesia. No significant differences between study groups as regardingthe hemodynamic parameters. Group-N had a significantly prolonged time to 1st analgesic request, lower total rescue analgesia consumption, and more parents’ satisfaction scores. No serious adverse effects were recorded during the study. Conclusion Adding nalbuphine to bupivacaine during pediatric caudal block had no significantly different effects on postoperative EA (PAED score). Both drugs decreased the incidence of EA with less severity in the nalbuphine group. Nalbuphine also decreases postoperative pain with more sedation.

Abstract Background Emergence agitation or emergence delirium is a common complication of unknown etiology in pediatric anesthesia. Pediatric anesthesia emergence delirium (PAED) has been reported most commonly in younger children and may occur in about 30% of children up to 5–6 years old. Exposure to anesthetic agents may contribute to PAED, and we hypothesized that a management strategy to minimize exposure to volatile anesthetics may reduce PAED. Electroencephalography (EEG) signatures captured and displayed by brain function monitors during anesthesia change with concentration of sevoflurane and level of unconsciousness, and these EEG signatures may be used to inform titration of anesthetics. Methods A single-center, parallel-group, two-arm, superiority trial with a 1:1 allocation ratio will be performed to compare the incidence of PAED following standard sevoflurane anesthesia (maintained at 1.0MAC) and EEG-guided anesthesia (minimum concentration to sustain surgical anesthesia as determined by monitoring of EEG signatures). Participants between 1 and 6 years of age undergoing surgical procedures involving minimal postoperative pain will be randomly assigned to receive standard (n = 90) or EEG-guided (n = 90) anesthesia. PAED score will be assessed by a blinded observer in the PACU on arrival and after 5, 10, 15, and 30 min. Discussion Anesthesia management with proactive use of brain function monitoring is expected to reduce exposure to sevoflurane without compromising surgical anesthesia. We expect this reduced exposure should help prevent PAED. Routinely administering what may be considered standard levels of anesthetic such as 1.0 MAC sevoflurane may be excessive and potentially associated with unfavorable sequelae such as PAED. Trial registration Japan Registry of Clinical Trials (jRCT) jRCTs032210248. Prospectively registered on 17 August 2021.

Abstract Background Some studies reported that pediatric patients undergoing otorhinolaryngology (ENT) and ophthalmic surgeries have higher incidences of emergence agitation (EA). Children with EA tend to carry the risk of self-harm, have longer periods of recovery and delayed hospital discharge. Consequently, EA needs to be monitored and risk factors ought to be emphasized to implement preventative measures. The objective of this study was to describe EA and to identify risk factors after pediatric ophthalmic or ENT surgery. Methods Between September 2021 and December 2021, a cross-sectional study was conducted in 100 children aged of 0–12 years who underwent ophthalmic or ENT surgery. The Watcha scale was used to observe and record EA, which was defined at levels of 3 or 4 at any time in the post-anesthesia care unit (PACU). The pain intensity was graded with the Face, Legs, Activity, Cry, Consolability (FLACC) Scale after surgery. Patient and surgery-related characteristics, the behavioral criteria of EA, the pharmacologic and non-pharmacologic interventions and recovery outcomes were objectively recorded. A binary logistic regression model was constructed to identify the associated factors of EA. Results From the 100 analyzed children, 58 were males and 42 were females, and 44 patients received ophthalmic surgery and 56 ENT surgery. The median age was 6 (IQR 4–7) years. The overall incidence of EA among pediatrics was 30% (34.5% for ENT and 24.4% for ophthalmic surgery). High preoperative modified Yale Preoperative Anxiety scale (m-YPAS) grade (OR = 1.19, 95%CI 1.06–1.33, P = 0.003) and high postoperative FLACC score (OR = 3.36, 95%CI 1.88–6.02, P

Abstract Background Emergence agitation (EA) is a prevalent complication in children following general anesthesia. Several studies have assessed the relationship between melatonin or its analogs and the incidence of pediatric EA, yielding conflicting results. This meta-analysis aims to assess the effects of premedication with melatonin or its analogs on preventing EA in children after general anesthesia. Methods PubMed, EMBASE, the Cochrane Library, ProQuest Dissertations & Theses Global, Web of Science, CNKI, Wanfang Data, clinicaltrials.gov, and WHO International Clinical Trials Registry Platform were searched until 25 November 2022. We included randomized controlled trials that assessed EA in patients less than 18 years old who underwent general anesthesia. We excluded studies that did not use a specific evaluation to assess EA. Results Nine studies (951 participants) were included in this systematic review. Melatonin significantly reduced the incidence of EA compared with placebos (risk ratio 0.40, 95% CI 0.26 to 0.61, P

Background: The occurrence of emergence agitation (EA) is the most common and practical problem faced in the immediate post-operative period during the process of Extubation under General Anaesthesia. Dexmedetomidine, an α2 adrenoceptor agonist is an excellent drug that has been shown effective to decrease the preoperative anxiety and smooth induction and emergence. Aims and Objectives: To assess the effect of intravenous dexmedetomidine primarily on EA and other complications that may occur during emergence from general anesthesia. Materials and Methods: 80 patients of either gender aged 18–65 years with ASA status I and II, undergoing various elective general and urological surgeries under general anesthesia were included in the study. Patients receiving adjuvant drug dexmedetomidine, were labelled as Group D (n=40) and those who didn’t receive any adjuvant were labelled as group C (n=40). Dexmedetomidine was given at 1 μg/kg and then maintained at infusion of 0.4 μg/kg/h till the end of the surgery for group D. The hemodynamic parameters and SpO2 were measured during the intraoperative period at various intervals of time till the end of surgery and also on arrival to the recovery room till patient was discharged from post-anesthesia care unit in both the groups. Results: The use of IV dexmedetomidine has proved significantly effective in prevention of incidence of EA with the overall incidence of agitation of 7.5% in Group D as compared to 42.5% in group C. Conclusion: Intraoperative administration of intravenous dexmedetomidine decreased the incidence of EA and other emergence phenomena like cough, pain and PONV with stable hemodynamics, safety profile, good analgesic properties and opioids sparing side effects.

Jinjuan Duan,&ast; Xia Ju,&ast; Xing Wang, Ning Liu, Siqi Xu, Shengbin Wang Department of Anesthesiology, Affiliated Anqing Medical Centre of Anhui Medical University, Anqing Municipal Hospital, Anqing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Siqi Xu; Shengbin Wang, Department of Anesthesiology, Affiliated Anqing Medical Centre of Anhui Medical University, Anqing Municipal Hospital, No. 87 Tianzhushan Road, Anqing, 246000, People’s Republic of China, Tel +86-13865192106 ; +86-13955665151, Email errtg555@163.com; shbw1965@126.comPurpose: The aim of this study was to compare the effects of remimazolam and propofol on emergence agitation (EA) in elderly patients undergoing hip replacement.Methods: A total of 60 elderly patients undergoing hip replacement were recruited for this prospective, single-center, clinical, randomized, controlled study from February to April 2023. They were randomly assigned to two groups: the remimazolam group (group R) and the propofol group (group P). In group R, remimazolam was administered intravenously during the induction and maintenance of anesthesia, In group P, propofol was used during the induction and maintenance of anesthesia. The incidence of EA was recorded as the primary indicator. Secondary indicators included heart rate (HR) and mean arterial pressure (MAP) values at the following moments: 5 min prior to anesthetic induction (T0), 1 min following induction (T1), 5 min after the laryngeal mask was inserted (T2), the beginning of surgery (T3), the moment the laryngeal mask was removed (T4), and the overall incidence of postoperative adverse events (bleeding or splitting of the surgical incision, removal of the intravenous infusion needle, falling off the bed, hypoxemia, and hypertension).Results: The incidence of EA was significantly lower in group R than in group P (10% vs 33%, P < 0.05). At T1, T2, and T3, the HR and MAP values of group R were higher than those of group P (P < 0.05). The overall incidence of postoperative adverse events was significantly lower in group R than in group P (P < 0.05).Conclusion: Remimazolam further reduced the incidence of emergence agitation when compared to propofol during geriatric hip replacement. Moreover, it has a minor hemodynamic effect and lower the incidence of postoperative adverse events.Keywords: remimazolam, propofol, emergence agitation, elderly, hip replacement

Dental anxiety is a widespread complication occurring in pediatric patients during dental visits and may lead to undesirable complications. Esketamine may be effective in anxiety. The objective of this study was to investigate the effect of premedication with a dexmedetomidine-esketamine combination compared with dexmedetomidine alone on dental anxiety in preschool children undergoing dental treatment under general anesthesia. This is a prospective, double-blinded, randomized controlled trial. A total of 84 patients were scheduled for elective outpatient dental caries treatment under general anesthesia. Patients were randomly premedicated with intranasal dexmedetomidine (group D) or intranasal dexmedetomidine-esketamine (group DS). The primary outcome was the level of dental anxiety assessed by the Modified Child Dental Anxiety Scale (MCDAS) at 2 h after surgery. Secondary outcomes included level of dental anxiety at 1 day and 7 days after surgery, the incidence of dental anxiety at 2 h, 1 day, and 7 days after surgery, sedation onset time, overall success of sedation, acceptance of mask induction, postoperative pain intensity, incidence of emergence agitation in PACU, adverse reactions, HR, and SpO2 before premedication (baseline) and at 10, 20, and 30 min after the end of study drug delivery. The dental anxiety in group DS was lower than that in group D at 2 h, 1 day, and 7 days postoperatively (P = 0.04, 0.004, and 0.006, respectively). The incidences of dental anxiety in group DS were lower than those in group D at 2 h (53 % vs 76 %, P = 0.03), 1 day (47 % vs 71 %, P = 0.04), and 7 days (44 % vs 71 %, P = 0.02) after surgery. Group DS had a higher success rate of sedation (P = 0.03) but showed a lower MAS score (P = 0.005) and smoother hemodynamics (P < 0.01) after drug administration than group D. Group DS showed a significantly lower incidence rate of emergence agitation (P = 0.03) and postoperative pain intensity (P = 0.006) than that in group D during the anesthesia recovery time. The occurrence of adverse reactions was similar in both groups (P > 0.05). We did not analyze and correct for the learning effect caused by repeated applications of the MCDAS and MCDAS scores on the 1 day after surgery were obtained by telephone follow-up. Compared to premedication with dexmedetomidine alone, premedication with intranasal dexmedetomidine combined with esketamine could significantly improve dental anxiety in preschool children undergoing dental treatment under general anesthesia. • Evidence regarding effects of esketamine on dental anxiety has been limited. • Intranasal dexmedetomidine combined with esketamine improves dental anxiety in children undergoing dental surgery. • Premedication with dexmedetomidine and esketamine reduces emergence agitation and postoperative pain in children. [ABSTRACT FROM AUTHOR]

Background: Oral midazolam is the most commonly used sedative premedication agent in pediatric patients. While effective, oral midazolam cannot reduce the incidence of emergence agitation. Oral dexmedetomidine may be effective in providing satisfactory sedation and reduce the incidence of emergence agitation, although the results of different randomized controlled trials are conflicting. Methods: This study enrolled randomized controlled trials (RCTs) examining premedication with oral dexmedetomidine versus oral midazolam in pediatric patients undergoing general anesthesia. PubMed, the Cochrane Library, Embase, and the Web of Science database were searched from their inception until June 2023. The outcomes were the incidence of satisfactory preoperative sedation, satisfactory sedation during separation from parents, satisfactory sedation during anesthesia induction using an anesthesia mask, and the incidence of emergence agitation. Results: A total of 9 RCTs comprising 885 patients were analyzed. Our data revealed comparable effects of dexmedetomidine and midazolam with respect to satisfactory preoperative sedation and a satisfactory incidence of sedation during parental separation and mask acceptance before anesthesia induction. Notably, our data revealed that the rate of emergence agitation was significantly lower in pediatric patients receiving dexmedetomidine (n = 162) than in those receiving midazolam (n = 159) (odds ratio = 0.16; 95% confidence interval: 0.06 to 0.44; p < 0.001; I2 = 35%). Conclusions: Data from this meta-analysis revealed comparable effects for premedication with oral dexmedetomidine or oral midazolam with respect to satisfactory sedation; furthermore, premedication with oral dexmedetomidine more effectively mitigated emergence agitation in pediatric patients receiving general anesthesia compared with oral midazolam. [ABSTRACT FROM AUTHOR]

Background: Emergence agitation and delirium in children remain a common clinical challenge in the post‐anesthetic care unit. Preoperative oral melatonin has been suggested as an effective preventive drug with a favorable safety profile. The oral bioavailability of melatonin, however, is low. Therefore, the MELA‐PAED trial aims to investigate the efficacy and safety of intraoperative intravenous melatonin for the prevention of emergence agitation in pediatric surgical patients. Methods: MELA‐PAED is a randomized, double‐blind, parallel two‐arm, multi‐center, superiority trial comparing intravenous melatonin with placebo. Four hundred participants aged 1–6 years will be randomized 1:1 to either the intervention or placebo. The intervention consists of intravenous melatonin 0.15 mg/kg administered approximately 30 min before the end of surgery. Participants will be monitored in the post‐anesthetic care unit (PACU), and the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ‐AS) will be performed on days 1, 7, and 14 after the intervention. Serious Adverse Events (SAE) will be assessed up to 30 days after the intervention. Results: The primary outcome is the incidence of emergence agitation, assessed dichotomously as any Watcha score >2 during the participant's stay in the post‐anesthetic care unit. Secondary outcomes are opioid consumption in the post‐anesthetic care unit and adverse events. Exploratory outcomes include SAEs, postoperative pain, postoperative nausea and vomiting, and time to awakening, to first oral intake, and to discharge readiness. Conclusion: The MELA‐PAED trial investigates the efficacy of intravenous intraoperative melatonin for the prevention of emergence agitation in pediatric surgical patients. Results may provide further knowledge concerning the use of melatonin in pediatric perioperative care. [ABSTRACT FROM AUTHOR]

Children who experience Emergence Delirium following an anaesthetic are at an increased risk of injury, harm to the surgical site, delayed discharge from the recovery room/ post anaesthetic care unit, an increased length of stay in hospital, the requirement of additional nursing staff to care for them and may display additional emotional and behavioural upsets in the weeks following surgery. Many factors have been postulated to be associated with the development of Emergence Delirium in children. However, to date the strength and nature of these associations has not been thoroughly investigated nor discussed considering the specific implications for contemporary nursing practice. The aim of this scoping review is to provide an overview of Emergence Delirium in children, and a critical synthesis of evidence informing development of nursing interventions to prevent or minimise paediatric Emergence Delirium. This scoping review was conducted guided by the PRISMA checklist. 14 peer-reviewed studies and guidelines published between 2000 and 2020 on Emergence Delirium in children and nursing practice were included in the deductive thematic analysis stage. The results found the anxiety of the child, the post-operative phase, continuity of care and medication administration were key themes in the nursing management of Emergence Delirium. There is opportunity for further research to be conducted on child Emergence Delirium in different hospital systems with further exploration of nurse-led interventions. [ABSTRACT FROM AUTHOR]

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Background and aim: Emergence agitation (EA) after general anesthesia is common in patients with post-traumatic stress disorder (PTSD). Due to the recent worldwide events such as the Covid-19 pandemic and wars, PTSD is not rare. Accordingly, a reliable, cost-effective anesthetic protocol to lower the incidence of EA is crucial. Therefore, we aimed to compare three different interventions for avoiding EA in PTSD patients undergoing gynecological laparoscopic surgery. Participants were divided into four groups: 1: performing pre-operative relaxation techniques (deep breathing exercise and progressive muscle relaxation [PMR]); 2: administrating intra-operative Ketamine; 3: applying both previously mentioned strategies and 4 as controls. Methods: This study was carried out on 144 adult women scheduled for gynecological laparoscopy, randomly allocated into four groups: three intervention groups and a control group (36 each). Women aged 18-45 years old, with a diagnosis of PTSD were included in the study. Patients with a positive history of major neurological, cardiovascular, metabolic, respiratory, or renal disease were excluded. Any patient who reported the use of psychiatric drugs were also excluded from the study. Data was analyzed using IBM SPSS Statistics software version 26. Kolmogorov- Smirnov was used to verify the normality of the distribution of variables. Odds ratio was calculated to clarify the strength and direction of the association between intervention groups and control. Data was deemed significant at a p-value ≤0.05. Results: Heart rate (HR) and Mean Arterial Blood Pressure (MABP) intra-operative and post-operative till 24 hours were significantly lower in groups 1, 2, and 3 compared to group 4 (p<0.001). There was a significant statistical difference in the intraoperative HR percentage decrease. MABP percentage decrease post-operative was higher in all the intervention groups with no statistically significant difference, except for group 1 compared to group 4, which was statistically significant (12.28 ± 11.77 and 6.10 ± 7.24, p=0.025). Visual Analogue Scale measurements were significantly less in the intervention groups 1, 2, and 3 compared to group 4. On Riker sedation–agitation scores, group 1 was 85 times more likely to be non-agitated (85 (15.938 – 453.307), p<0.001), group 2 was 175 times more likely to be non-agitated (175 (19.932–1536.448), p<0.001) and group 3 was protected against agitation. Conclusion: Pre-operative relaxation techniques (breathing exercises and PMR) significantly lowered HR, MABP, VAS score, and EA than controls. These effects were not significantly different from intra-operative ketamine injection or the combination of both (relaxation techniques and ketamine). We recommend routine pre-operative screening for PTSD and the application of relaxation techniques (breathing exercises and PMR) in the pre-operative preparation protocol of PTSD-positive cases as well as routine practical application of preoperative relaxation techniques. Further studies on using pre-operative relaxation techniques in general could be cost-effective. [ABSTRACT FROM AUTHOR]

Background: Children's agitation increases following sevoflurane anaesthesia. With indefinite results, nalbuphine and midazolam have been used as preventative treatments. Patients and Methods: This study involved 90 children with American Society of Anesthesiologists score I-II and aged 4-10 who had sevoflurane-based adenotonsillectomy. Each child was randomly assigned to one of three groups; group N, group K, and group S. Nalbuphine was given to Group N at 0.1 mg/kg, ketamine was given to Group K at 0.25 mg/kg, and saline was given to Group S at equivalent volume. Sevoflurane was discontinued after the procedure, and the study drugs were given. The emergence agitation (EA) scale was used in the post-anesthesia care unit (PACU) to measure agitation upon admission (T0), after 5 min (T5), 10 min (T10), 15 min (T15), 20 min (T20), 25 min (T25), and 30 min (T30). Clinical trials. gov ID: NCT05176119. Results: In the PACU, the incidence of EA was significantly lowered in N (6.6%) and K Group (16.6%) compared to S group (33%) with (p = 0.044), the duration in PACU was significantly prolonged in S in comparison to K and N groups (p-value = 0.011), more patients experienced postoperative pain in S group compared to N group and K group (p-value < 0.001). Conclusion: Children who had sevoflurane-induced adenotonsillectomy can avoid emergence agitation with ketamine 0.25 mg/kg or nalbuphine 0.1 mg/kg. [ABSTRACT FROM AUTHOR]

Background Postoperative agitation is characterized by increased recovery time, irritability, and disorientation. This study hypothesized that adding nalbuphine to caudal bupivacaine could improve postoperative emergence agitation (EA). Methods Eighty children (2-12 years and ASA I-II) undergoing sub-umbilical abdominal surgeries were randomly allocated into two equal groups. Group-B received caudal bupivacaine 0.125 of 1 ml/kg plus 2 ml normal saline, whereas Group-N received caudal bupivacaine 0.125 of 1 ml/kg plus 0.2 mg/kg nalbuphine diluted in 2ml normal saline. We evaluated postoperative EA according to the pediatric anesthesia emergence delirium scale (PAED) on admission to the PACU and every 30 minutes for two hours postoperatively. Postoperative pain, sedation, rescue analgesia complications, and parents' satisfaction were also recorded. Results No statistically significant difference between both groups regarding the postoperative PAED scale at different times (p > 0.05), but inside each group, there was a significant decrease PAED scale at different times of assessment (p < 0.001) as compared to baseline data. Group-N had significantly better results concerning postoperative sedation and analgesia. No significant differences between study groups as regardingthe hemodynamic parameters. Group-N had a significantly prolonged time to 1st analgesic request, lower total rescue analgesia consumption, and more parents' satisfaction scores. No serious adverse effects were recorded during the study. Conclusion Adding nalbuphine to bupivacaine during pediatric caudal block had no significantly different effects on postoperative EA (PAED score). Both drugs decreased the incidence of EA with less severity in the nalbuphine group. Nalbuphine also decreases postoperative pain with more sedation. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of comprehensive nursing interventions in operating room on emergence agitation (EA) in patients undergoing oral and maxillofacial surgery under general anesthesia. Methods Totally 88 patients undergoing elective oral and maxillofacial surgery under general anesthesia were randomly divided into control group and observation group, 44 cases in each group. The control group received routine surgical nursing, and the observation group received comprehensive surgical nursing on the basis of routine nursing. The incidence of EA, recovery time, extubation time, heart rate and blood pressure during recovery period were compared between the two groups. The psychological status before and after intervention was measured by simple psychological rating scale Kessler 10, and complications during recovery period were recorded. Results The incidence of EA in the observation group (6. 82 %) was lower than that in the control group (22. 73 %) (P＜0. 05). The recovery time and extubation time of the observation group were shorter than those of the control group(P＜0. 01). After entering the anesthesia recovery room for 30 min, the heart rate, systolic blood pressure and diastolic blood pressure in the observation group were lower than those in the control group(P＜0. 01). After intervention, score of Kessler 10 in both groups was lower than that before intervention, and that in the observation group was lower than the control group (P＜0. 01). The total incidence of other complications in the observation group was 9. 09 %(4/44), which was lower than 25. 00 %(11/44) in the control group (P＜0. 05). Conclusion Comprehensive nursing interventions in operation room can effectively reduce the occurrence of EA and improve the recovery of patients with oral and maxillofacial surgery under general anesthesia (目的 探讨手术室综合护理干预对口腔颌面全麻手术患者苏醒期躁动(EA)的影响。方法 选取择期行口腔颌面全麻手术的88例患者为研究对象, 按照随机数字表法将患者分为对照组和观察组, 各44例。对照组实施手术室常规护理, 观察组在常规护理基础上实施手术室综合护理。比较两组EA发生率、苏醒时间及拔气管插管时间、苏醒期心率及血压情况, 采用简易心理状况评定量表Kessler 10评估干预前后心理状态, 并记录苏醒期其他并发症情况。结果 观察组EA发生率6. 82%(3/44), 低于对照组的22. 73%(10/34), 差异有统计学意义(P＜0. 05)。观察组苏醒时间及拔气管插管时间均短于对照组(P＜0. 01)。进入麻醉恢复室30min后, 观察组心率、收缩压及舒张压均低于对照组(P＜0. 01)。干预后, 两组Kessler 10量表评分均较干预前降低, 且观察组低于对照组(P＜0. 01)。观察组其他并发症总发生率为9. 09%(4/44), 低于对照组的25. 00%(11/44), 差异有统计学意义(P＜0. 05)。结论 对口腔颌面全麻手术患者实施手术室综合护理干预, 能有效减少EA的发生, 提高苏醒质量。)