Emergence From Anesthesia
Conditions
Keywords
Emergence from Anesthesia, Anterior temporal lobectomy, Amygdalohippocampectomy, Anesthesia
Brief summary
Smooth emergence (wake up) from anesthesia is an important consideration in patients undergoing neurosurgical procedures as blood pressure changes associated with violent emergence can cause intracranial hemorrhage and brain swelling. At the same time, emergence should also be quick so that patients' neurological function can be assessed at a timely manner. Pattern of emergence from anesthesia is poorly investigated and understood.
Detailed description
Epilepsy surgery involves resecting epileptogenic tissues including limbic structures which may be functionally normal. Hence the emergence process can be complicated in patients having diseased limbic structures or those having therapeutic removal of limbic structures as in epilepsy surgery. Limbic structures are responsible for memory, language and executive function and hence loss of some of these higher functions is to be expected in the postoperative period. Preoperative neuropsychological assessments are often used to predict their risk for postoperative loss of higher functions and behavior changes. In our experience the investigators have seen that there is a spectrum of emergence characteristics in patients undergoing temporal lobectomy that can vary from dangerously agitated patient to much sedated, unarousable patient. Delirium and agitation can be dangerous and have serious consequences for the patient such as injury, increased pain, hemorrhage, self-extubation and removal of catheters requiring physical or chemical restraint. On the other hand the unarousable patient may pose dangerous airway complications and limit neurological assessment in the immediate postoperative period. Hence it is essential to have a clue about post anesthesia emergence behavior in patients having epilepsy surgeries. The aim of this study is to look at the pattern of emergence from anesthesia after epilepsy surgery and to determine if preoperative neuropsychological assessment help predict the pattern of emergence in patients undergoing anterior temporal lobectomy and amygdalohippocampectomy.
Interventions
There are no study related interventions in this study and perioperative care of these patients will be as per our standard practice The only study related protocol would be collecting the data on the emergence from anesthesia. The data will be collected from the time of turning off the anesthetic agents till the discharge from recovery room. Data collected include, vital signs, Glasgow coma scale( GCS), and Riker agitation- sedation score.. The patients will be assessed every 5 minutes for the first 30 minutes and every 10 minutes for the next 60 minutes.
Sponsors
University Health Network, Toronto
Lashmi Venkatraghavan
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult patients above the age of 18 who are scheduled for elective anterior temporal lobectomy and amygdalohippocampectomy under General Anesthesia
Exclusion criteria
* Lack of informed consent Patients needing intensive care unit postoperatively
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Volumes of the Hippocampus, Thalamus and Amygdala | 1 day | Comparison of volumes of the hippocampus, thalamus and amygdala between Agitated and Smooth emergence groups |
Countries
Canada
Participant flow
Recruitment details
all patients will be seen by the anesthesiologists in the pre-anesthesia consult clinic.
Pre-assignment details
Intraoperatively, all patients will have standard monitoring consisting of electrocardiography (ECG), pulse oximetry, end-tidal carbon dioxide (ETCO2), invasive and non-invasive blood pressure, temperature, urine output, depth of anesthesia (Entropy) and end tidal anesthetic agent concentration.
Participants by arm
| Arm | Count |
|---|---|
| Agitated Emergence Demographic variables of patients woke up agitated from anesthesia | 9 |
| Smooth Emergence Demographic variables of patients with smooth wake up from anesthesia | 20 |
| Total | 29 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Physician Decision | 7 |
Baseline characteristics
| Characteristic | Agitated Emergence | Smooth Emergence | Total |
|---|---|---|---|
| Age, Customized Age | 33 years STANDARD_DEVIATION 11 | 36 years STANDARD_DEVIATION 13 | 34.5 years STANDARD_DEVIATION 12 |
| Height | 174 cm STANDARD_DEVIATION 10 | 170 cm STANDARD_DEVIATION 9 | 172 cm STANDARD_DEVIATION 8 |
| Race and Ethnicity Not Collected | — | — | 0 Participants |
| Sex/Gender, Customized Sex/Gender data were not collected. | 0 Participants | 0 Participants | 0 Participants |
| Weight | 76 Kg STANDARD_DEVIATION 15 | 75 Kg STANDARD_DEVIATION 19 | 75.5 Kg STANDARD_DEVIATION 17 |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 29 |
| other Total, other adverse events | 0 / 29 |
| serious Total, serious adverse events | 0 / 29 |
Outcome results
Primary
Volumes of the Hippocampus, Thalamus and Amygdala
Comparison of volumes of the hippocampus, thalamus and amygdala between Agitated and Smooth emergence groups
Time frame: 1 day
Population: Comparison of volumes of the hippocampus, thalamus and amygdala in both groups
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Agitated Emergence | Volumes of the Hippocampus, Thalamus and Amygdala | ipsilateral hippocampus | 3578 mm3 | Standard Deviation 344 |
| Agitated Emergence | Volumes of the Hippocampus, Thalamus and Amygdala | contralateral hippocampus | 3479 mm3 | Standard Deviation 452 |
| Agitated Emergence | Volumes of the Hippocampus, Thalamus and Amygdala | ipsilateral thalamus | 7311 mm3 | Standard Deviation 663 |
| Agitated Emergence | Volumes of the Hippocampus, Thalamus and Amygdala | contralatera thalamus l | 7608 mm3 | Standard Deviation 908 |
| Agitated Emergence | Volumes of the Hippocampus, Thalamus and Amygdala | ipsilateral amygdala | 1331 mm3 | Standard Deviation 272 |
| Agitated Emergence | Volumes of the Hippocampus, Thalamus and Amygdala | contralateral amygdala | 1321 mm3 | Standard Deviation 223 |
| Smooth Emergence | Volumes of the Hippocampus, Thalamus and Amygdala | ipsilateral amygdala | 1295 mm3 | Standard Deviation 285 |
| Smooth Emergence | Volumes of the Hippocampus, Thalamus and Amygdala | ipsilateral hippocampus | 3903 mm3 | Standard Deviation 516 |
| Smooth Emergence | Volumes of the Hippocampus, Thalamus and Amygdala | contralatera thalamus l | 7631 mm3 | Standard Deviation 799 |
| Smooth Emergence | Volumes of the Hippocampus, Thalamus and Amygdala | contralateral hippocampus | 3525 mm3 | Standard Deviation 569 |
| Smooth Emergence | Volumes of the Hippocampus, Thalamus and Amygdala | contralateral amygdala | 1260 mm3 | Standard Deviation 230 |
| Smooth Emergence | Volumes of the Hippocampus, Thalamus and Amygdala | ipsilateral thalamus | 7479 mm3 | Standard Deviation 856 |