Risk Factors for Emergence Agitation in Adults Undergoing Thoracoscopic Lung Surgery: A Case-Control Study of 1,950 Patients

Xianhui Kang; Kun Lin; Hongli Tang; Xiaodong Tang; Fangping Bao; Shuyuan Gan; Shengmei Zhu

doi:10.1053/j.jvca.2020.02.046

Risk Factors for Emergence Agitation in Adults Undergoing Thoracoscopic Lung Surgery: A Case-Control Study of 1,950 Patients

J Cardiothorac Vasc Anesth. 2020 Sep;34(9):2403-2409. doi: 10.1053/j.jvca.2020.02.046. Epub 2020 Mar 2.

Authors

Xianhui Kang¹, Kun Lin¹, Hongli Tang², Xiaodong Tang¹, Fangping Bao¹, Shuyuan Gan¹, Shengmei Zhu³

Affiliations

¹ Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
² Department of Anesthesiology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
³ Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China. Electronic address: smzhu20088@zju.edu.cn.

PMID: 32418835
DOI: 10.1053/j.jvca.2020.02.046

Abstract

Objective: The present study investigated the incidence of and risk factors for emergence agitation (EA) in adult patients after thoracoscopic lung surgery.

Design: A retrospective case-control study.

Setting: Single-center university hospital.

Participants: The study comprised 1,950 adult patients who underwent elective lung surgery from January to December 2016.

Interventions: None.

Measurements and main results: Preoperative, surgical, and anesthesia-related data were collected. EA was assessed with the Riker Sedation-Agitation Scale and defined as a Riker score ≥5. Univariate analyses and multivariate logistic regression analysis were used to identify risk factors for EA. The incidence of EA was 14.1%. The results of the multivariate analysis showed that male sex (odds ratio [OR] 1.877, 95% confidence interval [CI] 1.341-2.627), age ≥65 years (OR 1.424, 95% CI 1.074-1.889), body mass index ≥24 kg/m² (OR 1.409, 95% CI 1.070-1.856), American Society of Anesthesiologists physical status Ⅲ or Ⅳ (OR 2.654, 95% CI 1.189-5.924), cigarette smoking (OR 1.553, 95% CI 1.108-2.177), duration of surgery (OR 1.006, 95% CI 1.003-1.009), intraoperative tachycardia (OR 1.721, 95% CI 1.058-2.802), intraoperative hypotension (OR 1.636, 95% CI 1.064-2.514), intraoperative hypertension (OR 1.608; 95% CI 1.056-2.448), and rescue analgesia (OR 1.810, 95% CI 1.235-2.653) were independent risk factors for EA. However, wound infiltration (OR 0.679, 95% CI 0.507-0.908) and the use of dexmedetomidine (OR 0.663, 95% CI 0.490-0.869) appeared to be protective factors against EA.

Conclusion: EA is a common complication after thoracoscopic lung surgery, especially within a certain population. Adequate perioperative management, which comprises wound infiltration, the maintenance of intraoperative hemodynamic stability, sufficient analgesia, and the use of dexmedetomidine, should be adopted to reduce the incidence of EA.

Keywords: adult; emergence agitation; risk factor; video-assisted thoracoscopic surgery.

MeSH terms

Adult
Aged
Anesthesia, General
Case-Control Studies
Emergence Delirium*
Humans
Lung
Male
Psychomotor Agitation
Retrospective Studies
Risk Factors