Emergence Agitation, Septoplasty Surgeries
Conditions
Keywords
anesthesia, emergence agitation, tiva
Brief summary
Adult patients undergoing septoplasty surgery will be evaluated in this study. The three different anesthesia methods used will be examined for psotoperative agitation: Total intravenous anesthesia (TIVA), Combined anesthesia with sevoflurane and intravenous agents (sevoflurane-CIVIA), Balanced inhalation anesthesia with sevoflurane. Recovery patterns is extubation time, eye opening time, emergence agitation, postoperative nausea and vomiting and postoperative recovery unit discharge time.
Detailed description
Agitation, defined as restlessness, disorientation, arousal, and/or inconsolable crying, is a common phenomenon seen in the early phase of recovery from general anesthesia. It can lead to respiratory depression, nausea, and vomiting, as well as increases in blood pressure, heart rate, and myocardial oxygen consumption. Hypoxia can lead to serious complications such as aspiration pneumonia, bleeding, or reoperation. Although its pathogenesis remains unclear, ear, nose, and throat (ENT) surgical procedures have been reported to have a higher incidence of agitation in both adults and children. Classic general anesthesia is performed with induction using an intravenous hypnotic such as propofol and maintenance with a volatile anesthetic such as sevoflurane, along with intermittent or continuous opioids and muscle relaxants. Opinions differ regarding the effects of inhalational and intravenous anesthesia on maintenance. A 2015 retrospective study investigating the risk factors for emergence agitation after rhinoplasty reported that sevoflurane use more than doubled the risk of emergence agitation. The use of propofol and sevoflurane for maintenance has recently been recommended due to the antiemetic effects of propofol, the myocardial protective effects of sevoflurane, and the potential for smoother emergence from the administration of small amounts of each anesthetic . This study aimed to compare the occurrence of emergence agitation after inhalation anesthesia, total intravenous anesthesia with TCI, and combined inhalation and intravenous anesthesia in patients undergoing septoplasty surgery.
Interventions
DRUGSEVOFLURANE
Anesthetic management will be made with sevoflurane
DRUGTIVA
Propofol and remifentanil will be given with TCİ device for anesthetic induction and management
DRUGCIVIA
In this group patients \<0.5 MAC sevoflurane will be used in combination with total intraveous method (This method described above )
Sponsors
Inonu University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SCREENING
Masking
DOUBLE (Subject, Caregiver)
Masking description
Participant: The participant will be unaware of which anesthesia method is performed in the perioperative period. Care Provider: The second anesthesiologist will wake the patient after the anesthesia has been terminated and will not know which anesthesia method was used.
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Age between 18 and 50 years old. * American Society of Anesthesiologists (ASA) Physical Status Class I or II. * Scheduled for elective septoplasty surgery. * Scheduled to receive general anesthesia
Exclusion criteria
* History of revision septoplasty * Known allergy to nonsteroidal anti-inflammatory drugs (NSAIDs) or the study drugs * History of bleeding disorder * History of allergy * ASA Physical Status greater than III * Body Mass Index (BMI) $\> 30 * History of hypertension, cardiovascular diseases, or cerebrovascular diseases * History of renal dysfunction * Use of psychiatric medications * History of substance abuse * Patients who refuse to participate
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Emergence agitation | Immediately after tracheal extubation | Emergence agitation will be assessed using the Richmond Agitation-Sedation Scale (RASS). RASS is a 10-point scale ranging from +4 to -5, measures agitation, sedation level, and responsiveness. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative nausea and vomiting (PONV) | Immediately post-op, 15 minutes, and 30 minutes in the Post-Anesthesia Care Unit (PACU) | Postoperative nausea and vomiting assessed on a 4-point scale: None: 0 Mild nausea: 1 Moderate nausea: 2 Frequent vomiting: 3 Severe vomiting: 4 |
| Extubation time | Immediately postoperative period | The time when patients are extubated after all anesthetic drugs have been discontinued |
| Recovery time | Continuous observation for 30 minutes in the PACU. | Recovery time is between the termination of anesthesia and the patient being discharged from the postoperative recovery room (PACU) with an Aldrete score of \>9. |
Countries
Turkey (Türkiye)
Contacts
STUDY_DIRECTORÜlkü Özgül, Professor
turgut özal medical center Department of Anesthesiology and Reanimation
Outcome results
None listed