A laparoscopic gastrectomy approach decreases the incidence and severity of emergence agitation after sevoflurane anesthesia

Abstract

Purpose: Compared to open gastrectomy (OG), laparoscopic gastrectomy (LG) has improved short-term outcomes and equivalent oncological outcomes. In this study, a potential short-term advantage of LG over OG, reduced risk of emergence agitation, was evaluated.

Methods: This retrospective study compared LG versus OG with respect to emergence agitation in 400 adult patients who underwent sevoflurane anesthesia. In all cases, a serial Richmond Agitation-Sedation Scale (RASS) assessment was performed in the postanesthesia care unit (PACU). Patients with a RASS score ≥+1 at any time were considered to have emergence agitation. Severe agitation was defined as a RASS score of +3 or +4.

Results: This study included 214 OG group subjects and 186 LG group subjects in the analysis. The overall incidence of emergence agitation was significantly lower in the LG group than the OG group (23.7 vs. 43.5 %, p < 0.001). The LG group had a significantly lower incidence of severe agitation than the OG group (1.1 vs. 4.7 %, p = 0.035). Multivariate logistic regression analysis demonstrated that the type of surgery (OG vs. LG), as well as current smoking, total dose of rescue opioids used in the PACU, and maximum pain score in the PACU, were independent risk factors for emergence agitation (odds ratio, 1.984; 95 % confidence interval, 1.249-3.153; p = 0.004). Patients with emergence agitation had significantly increased PACU stays (p = 0.024).

Conclusions: Compared to an open approach, a laparoscopic gastrectomy approach can provide the short-term benefit of decreased emergence agitation.