Yeon ju Kim, Jun-Young Jo, Seong-soo Choi, Kyung-don Hahm

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Yeon ju Kim, Jun-Young Jo, Seong-soo Choi, Kyung-don Hahm Comparison of Total Intravenous Anesthesia and Anesthesia and Volatile induction and maintenance on Emergence Agitation after Nasal Surgery in Adults : A Randomized Equivalence controlled Trial Yeon ju Kim, Jun-Young Jo, Seong-soo Choi, Kyung-don Hahm Department of Anesthesiology and Pain Medicine, Asan Medical Center, College of Medicine, Ulsan University, Seoul, Korea INTRODUCTION Table2. Intraoperative data Group TIVA (n=40) Group VA (n=40) P-value Anesthetic duration(min) 150.5 ± 89.31 138.0 ± 72.09 0.492 Operation duration(min) 102.6 ± 57.77 112.7 ± 66.04 0.469 Unilateral/Bilateral 9/ 31 (22.5/ 77.5) 13/ 27 (32.5/ 67.5) 0.317 Operation Endoscopic sinus surgery 15 (37.5) 20 (50.0) 0.260 Septo-or turbinoplasty 30 (75.0) >.999 Open rhinoplasty 12 (30.0) Endoscopic endonasal resection 5 (12.5) 4 (10.0) 0.723 Nasal packing (unilateral/Bilateral) 8/ 32 (20.0/ 80.0) 0.785 Emergence agitation (EA) is common after nasal surgery under general anesthesia. It may lead to serious consequences for the patient, such as increased risk of injury, increased pain, hemorrhage, and self-extubation. Hypothesis: “Total Intravenous Anesthesia is better than inhalational anesthesia considering emergence agitation in nose surgery.” METHODS All consecutive adult patients who underwent elective nasal surgery between August 2016 and October 2016 open rhinoplasty, septoplasty, turbinoplasty, endoscopic sinus surgery, functional endoscopic sinus surgery Exclusion: patients with history of administration of neuroleptics or benzodiazepine over 2 weeks before surgery Patients with mental disorder based on DSM-IV definition definition of emergence agitation Richmond Agitation Sedation Scale (RASS) ≥ +1 Riker Sedation-Agitation Scale (RSAS) ≥ 5 Carry out an evaluation of EA and postoperative complications immediate after extubation Patients with a RASS ≥ +1 immediate after extubation were lower in TIVA group than VIMA group (2.5% vs 20.0%, p < 0.05). Similarly, patients with a RSAS ≥ 5 were lower in TIVA group than VIMA group (2.5% vs 25.0%, p < 0.05). Figure.2 Incidence of emergence agitation Figure 1. Consort diagram Table 3. Postoperative data Group TIVA (n=40) Group VA (n=40) P-value Postoperative EA RASS 1 (2.5) 8 (20.0) 0.029 RSAS 10 (25.0) 0.007 Complications 0.348 Cough 4 (10.0) Laryngospasm 0 (0.0) Desaturation RESULTS Immediate postoperative complications, such as cough, laryngospasm, desaturation, did not different in both groups. Postoperative need for rescue analgesia and incidence of complications, such as postoperative nausea and vomiting, itching or urticaria, shivering, desaturation also did not different in both groups. Demographic characteristics and intraoperative parameters were similar between two groups. Table 1. Basal Characteristics of study population Group TIVA (n=40) Group VA (n=40) P-value Age (y) 43.3 ± 19.0 39.9± 16.7 .395 Weight (kg) 66.6±9.87 66.0 ± 11.05 .803 Height (cm) 169.6± 9.9 166.7± 1.43 .162 Gender (M/F) 31(77.5)/9(22.5) 24(60.0)/16(40.0) .091 BMI* ( kg/m2) 23.1±2.5 23.7±3.3 .354 ASA† (1/2/3) 28/11/1(70.0/27.5/2.5) 25/15/0(62.7/37.5/0.0) .474 Comorbidity Hypertension 8(20.0) 7(17.5) .775 Diabetes mellitus 3(7.5) >.999 Asthma/COPD 1(2.5) 2 (5.0) Smoking 11(27.5)/1(2.5) 15(37.5) * BMI; body mass index † ASA; American Society of Anesthesiologists physical status ‡ Smoking: ex-smoker/current smoker CONCLUSIONS Immediately postoperative emergence agitation in adult occurs not infrequently in nasal surgery. TIVA could be the better choice in nasal surgery with regard to postoperative emergence agitation.