Demir Canser Yilmaz, Yuzkat Nureddin
Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey.
Department of Anesthesiology and Reanimation, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey.
Aesthetic Plast Surg. 2018 Jun;42(3):847-853. doi: 10.1007/s00266-018-1103-4. Epub 2018 Feb 20.
Emergence agitation (EA), defined as restlessness, disorientation, excitation, and/or inconsolable crying, is a common phenomenon during early recovery from general anesthesia. In this study, we aimed to determine the (1) EA incidence after rhinoplasty operations in adults; (2) the effects of ketamine administered at sub-anesthetic doses just 20 min before the end of the surgery in rhinoplasty operations on agitation level, postoperative pain, side effects, and complications; and (3) to determine the risk factors for EA in adults after rhinoplasty.
Totally 140 patients scheduled to undergo elective rhinoplasty were enrolled in this prospective study. Patients were equally and randomly divided into two groups: saline group (control group) (n = 70) and ketamine group (n = 70). Twenty minutes before surgery completion, 1 ml saline was administered via the intravenous (i.v.) route to the saline group, while 0.5 mg/kg ketamine was administered via i.v. patients in the ketamine group. The emergence agitation level of the patients was evaluated using the Richmond Agitation-Sedation Scale just after extubation and in the post-anesthesia care unit (PACU). For postoperative pain evaluation, the Numerical Rating Scale (NRS) was scored (from 0 to 10) every 10 min until the patients were discharged from PACU.
EA incidence in the control group was as high as 54.3%, while in the ketamine group it was 8.6% just after extubation (p < 0.001). In the PACU, EA incidence was 28.6% in the control group, while none of the patients had EA in the PACU in the ketamine group (p < 0.001). Male gender, severe pain (NRS ≥ 5), and smoking were defined as significant risk factors for EA both after extubation and during follow-ups in the PACU (p < 0.001).
Emergence agitation after rhinoplasty is a common complication, likely disturbing operative outcomes in adults. Ketamine at sub-anesthetic doses is highly effective in preventing EA. Further, larger-scale prospective studies are warranted to determine preventive measures for EA development in rhinoplasty.
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苏醒期躁动（EA）定义为烦躁不安、定向障碍、兴奋和/或无法安抚的哭闹，是全身麻醉早期恢复过程中的常见现象。在本研究中，我们旨在确定：（1）成人隆鼻手术后的EA发生率；（2）在隆鼻手术结束前20分钟给予亚麻醉剂量氯胺酮对躁动水平、术后疼痛、副作用和并发症的影响；（3）确定成人隆鼻术后EA的危险因素。
本前瞻性研究共纳入140例计划接受择期隆鼻手术的患者。患者被平均随机分为两组：生理盐水组（对照组）（n = 70）和氯胺酮组（n = 70）。手术结束前20分钟，经静脉途径给生理盐水组患者注射1 ml生理盐水，给氯胺酮组患者静脉注射0.5 mg/kg氯胺酮。在拔管后及麻醉后恢复室（PACU），使用里士满躁动镇静量表评估患者的苏醒期躁动水平。为评估术后疼痛，在患者从PACU出院前，每10分钟使用数字评分量表（NRS）（0至10分）进行评分。
对照组拔管后EA发生率高达54.3%，而氯胺酮组为8.6%（p < 0.001）。在PACU中，对照组EA发生率为28.6%，而氯胺酮组在PACU中无患者发生EA（p < 0.001）。男性、重度疼痛（NRS≥5）和吸烟被确定为拔管后及PACU随访期间EA的显著危险因素（p < 0.001）。
隆鼻术后苏醒期躁动是一种常见并发症，可能干扰成人手术结局。亚麻醉剂量的氯胺酮在预防EA方面非常有效。此外，有必要进行更大规模的前瞻性研究以确定隆鼻术中EA发生的预防措施。
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