The effect of deep and awake extubation on emergence agitation after nasal surgery: a randomized controlled trial

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 < 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.

Keywords: Emergence agitation; Extubation; Nasal surgery.

Fig. 1

CONSORT flow chart

Fig. 2

Ramsay, RASS, VAS, Number of agitation episodes at T1–T5. Figure note: * means p < 0.05 compared with T1, ** means p < 0.01 compared with T1, *** means p < 0.001 compared with T1. # means p < 0.05 between groups, ## means p < 0.01 between groups, ### means p < 0.001 between groups. RASS: Richmond Agitation-Sedation Scale, VAS: visual analog scale, EA: emergence agitation

Fig. 3

SpO2, HR, MAP, BIS value at T1–T5. Figure note: * means p < 0.05 compared with T1, ** means p < 0.01 compared with T1, *** means p < 0.001 compared with T1. # means p < 0.05 between groups, ## means p < 0.01 between groups, ### means p < 0.001 between groups. SpO2: peripheral arterial oxygen saturation, HR: heart rate, MAP: mean arterial pressure, BIS: bispectral index