The Effects of Three Different Anesthetic Methods on Postoperative Agitation

Comparison of the Effects of Three Different Anesthetic Methods on Postoperative Agitation in Septoplasty Surgery

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.

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.

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