1. 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.