Agitation States as Acute Reaction to Gross Stress
Conditions
Keywords
Nasal surgery, external nasal nerve block, postoperative agitation
Brief summary
Emergence agitation following general anaesthesia may lead to serious complications like self-extubation or removal of catheters, which can lead to hypoxia, aspiration pneumonia, bleeding or reoperation. Nose surgery is associated with a higher incidence of emergence agitation. The investigators planned to evaluate the efficacy of external nasal nerve block in prevention of postoperative agitation following external nasal surgeries under general anesthesia(GA).
Interventions
PROCEDUREExternal nasal nerve block
Three single (midline injection) and 4 paired (bilateral injection) sites to block the external nasal sensation.
DRUGsaline adrenaline
DRUGXylocaine, adrenaline
Sponsors
Al Jedaani Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
20 Years to 60 Years
Healthy volunteers
Yes
Inclusion criteria
* 110 adult patients of ASA physical status I and II, * Age 20-60 years, * Scheduled for elective external nasal surgeries in which nasal packing on each side was used postoperatively for 24 hours.
Exclusion criteria
1. History of uncontrolled hypertension, 2. Ischemic or valvular heart disease, 3. Use of MAO inhibitors or adrenergic blocking drugs, 4. Cognitive impairment, 5. Patients taking antipsychotics, 6. Renal insufficiency or liver dysfunction
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| postoperative agitation | Emergence is defined as the time interval from discontinuation of anesthesia to 5 min after extubation. | Assessment done using Richmond agitation- sedation scale (RASS) |
| Quality of recovery | 24 hours postoperative | Quality of recovery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Nausea and vomiting in PACU | one hour in PACU | Four-point nausea and vomiting scale (0=no nausea; 1=mild nausea; 2=severe nausea requiring antiemetics; and 3=retching, vomiting, or both) was also evaluated |
| Extubation time | Up to 15 after discontinuation of anesthesia | — |
| dose of fentanyl | intraoperative period in minutes | Fentanyl boluses were given in response to changes in hemodynamics (more than 15% increases in MAP and HR than the baseline values taken after induction by 5 minutes) |
| first verbal response time | up to 15 minutes | period from discontinuation of anesthesia 'time zero' to 1st verbal response in minutes |
| complication of nasal block | From injection to 24 hours postoperative | including local anesthetic systemic toxicity, vascular injury, intravascular injection of local anesthetic, and local hematoma. |
| Surgical time | duration of surgery in minutes up to 3 hours | intraoperative |
| morphine dose in PACU | one hour in PACU | equivalent morphine dose in PACU (calculated using opioid:morphine equivalents of 100 µg i.v. fentanyl to 10 mg i.v. morphine; 75- 100 mg IV pethidine to 10 mg i.v. morphine |
Countries
Saudi Arabia
Outcome results
None listed