Wegner Gustavo R M, Wegner Bruno F M, Oliveira Henrik G, Costa Luis A, Spagnol Luigi W, Spagnol Valentine W, de Oliveira Filho Gilberto T F
Universidade Federal da Fronteira Sul (UFFS), Faculdade de Medicina, Passo Fundo, RS, Brazil.
Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, Brazil.
Braz J Anesthesiol. 2025 Jan-Feb;75(1):844565. doi: 10.1016/j.bjane.2024.844565. Epub 2024 Oct 16.
Emergence agitation is a common complication after nasal surgeries, marked by increased agitation and a heightened risk of injuries. Factors like urinary catheter, endotracheal tube, postoperative pain, and younger age contribute to its occurrence. Due to the variety of preventive approaches reported in the literature, a network meta-analysis is essential.
This systematic review employs a network meta-analysis design, following Cochrane Handbook and PRISMA-NMA criteria. Inclusion criteria involve randomized controlled studies on pharmacological and non-pharmacological interventions for preventing emergence agitation in nasal surgeries. Electronic searches, including PubMed, Scopus, Embase, Cochrane Library, and Web of Science, without language or date restrictions, were conducted. Two independent reviewers selected studies, and data extraction was performed using standardized tables. Bayesian NMA, MetaInsight web app, and Cochrane Foundation Risk of Bias Assessment Tool were applied for data analysis and bias assessment.
After a rigorous selection process, 17 Randomized Controlled Trials (RCTs) encompassing 2,122 patients and 14 interventions were included. The best ranked treatments identified were intraoperative dexmedetomidine (1 μg.kg- for 10 minutes as a bolus, followed by 0.4 μg.kg.h), bilateral nasociliary and maxillary nerve block, ketamine (0.5 mg.kg administered 20 minutes before the end of surgery), nasal compression for 40 minutes before anesthesia induction, and suction above the cuff of the endotracheal tube.
Both pharmacological and non-pharmacological interventions emerged as effective strategies in mitigating emergence agitation after nasal surgeries, offering clinicians valuable options for improving postoperative outcomes in this patient population.
苏醒期躁动是鼻部手术后常见的并发症，表现为躁动加剧且受伤风险增加。导尿管、气管内插管、术后疼痛和年龄较小等因素会导致其发生。鉴于文献中报道的预防方法多种多样，进行网络荟萃分析至关重要。
本系统评价采用网络荟萃分析设计，遵循Cochrane手册和PRISMA-NMA标准。纳入标准包括关于预防鼻部手术苏醒期躁动的药物和非药物干预的随机对照研究。进行了电子检索，包括PubMed、Scopus、Embase、Cochrane图书馆和Web of Science，无语言或日期限制。两名独立评审员选择研究，并使用标准化表格进行数据提取。采用贝叶斯NMA、MetaInsight网络应用程序和Cochrane基金会偏倚风险评估工具进行数据分析和偏倚评估。
经过严格筛选，纳入了17项随机对照试验（RCT），涉及2122例患者和14种干预措施。确定的最佳治疗方法为术中使用右美托咪定（静脉推注1μg·kg，持续10分钟，随后0.4μg·kg·h）、双侧鼻睫状神经和上颌神经阻滞、氯胺酮（手术结束前20分钟静脉注射0.5mg·kg）、麻醉诱导前40分钟鼻腔压迫以及气管内插管套囊上方吸引。
药物和非药物干预均是减轻鼻部手术后苏醒期躁动的有效策略，为临床医生改善该患者群体的术后结局提供了有价值的选择。
