It’s Black Friday again, and the operating room is very busy on this day. My last ENT operation is going on, and it’s already 8 o’clock in the evening…
The patient is a male, 52 years old, 175cm tall, 75kg in weight, of good build,
He is a standard northern man. Except for smoking and drinking, he has no other bad habits. The results of the admission examination could not pick up any problems. The operation is to perform “bilateral nasal polypectomy” under general anesthesia. Everything was carried out step by step. The operation lasted 2 hours. I watched the surgeon fill the nasal cavity with a hemostatic sponge. I couldn’t help but feel a little excited. This means the operation is over. Couldn’t help but chuckle. Just then, something unexpected happened…
Patient wakes up with restless body language, he wakes up… Could it be that he cannot tolerate endotracheal intubation? ! Considering that the patient’s respiratory function had recovered, the tracheal intubation was decisively removed. But the ideal is plump, the reality is skinny, the patient’s agitation is more intense, the medical staff in the operating room are all in battle, protective restraint on the patient, and try their best to comfort the patient, all to no avail. It is obvious that the patient has agitation during the recovery period after general anesthesia, so what is the cause of the agitation?
Emergence Agitation EA (Emergence Agitation): an inappropriate behavior during anesthesia recovery, manifested as excitement, agitation and disorientation coexist, such as involuntary limb movements, incoherence, and irrationality Speech, crying or delusional thinking, etc. Dr. Eckenhoff first described this state in the 1960s as a state of post-anesthesia and considered a dissociative state of consciousness. Restlessness in the recovery period emphasizes the recovery period of anesthesia, usually within 1 hour after extubation, which is a problem we often encounter in clinical work. A common complication in the recovery period from general anesthesia can seriously affect the patient’s physiological function and surgical effect. , postoperative recovery and other adverse effects, if handled improperly, the consequences are serious, or even endanger the safety of patients. Restlessness during recovery is generally self-limited and returns to normal after the patient becomes conscious, that is, when the patient leaves the operating room, it has returned to normal.
There are three reasons for this: patient reasons, surgical reasons, and anesthesia reasons.
A domestic scholar has found through research that the incidence of delirium and agitation in preschool-aged children during recovery from sevoflurane is 40%, while that of school-aged children is 11.5%; the incidence of males is 27.81%, which is significantly higher than Female 14.39%.
For patients with severe agitation, under the condition of ensuring oxygen supply and airway patency, and closely monitoring vital signs, active drug treatment, including sedative drugs, opioids and non-steroidal drugs, etc. .
Midazolam and propofol are classic drugs for emergent agitation from general anesthesia, but use of midazolam in adults has been reported to increase the risk of emergent agitation and postoperative delirium ; Although propofol is effective, the effect can only last for tens of minutes. Continuous administration of propofol may lead to accumulation in elderly patients and inhibit breathing and circulation, so propofol is not the first choice. The use of low-dose dexmedetomidine in the early stage does not affect the breathing and circulation, and can also reduce the incidence of postoperative agitation and delirium in elderly patients.
Fortunately, after a few minutes of comfort, the patient’s mood gradually stabilized, and he could cooperate with the doctor to perform instructive actions, observe that the patient’s vital signs were stable, and then return to the ward. At the return visit the next day, the patient had no memory of the postoperative agitation.
Author: Jing Feng’e, Department of Anesthesia and Surgery, The First Affiliated Hospital of Henan University of Technology
[Warm reminder] Please pay attention, here are a lot of professional medical science, to reveal the secrets of surgical anesthesia for you~