Pre-operative administration of butorphanol mitigates emergence agitation in patients undergoing functional endoscopic sinus surgery: A randomized controlled clinical trial

Analysis of influencing factors and clinical application of a predictive model for emergence agitation from general anesthesia after abdominal surgery

OBJECTIVES

To identify factors influencing emergence agitation (EA) in abdominal surgery patients and develop a predictive model for early clinical intervention.

METHODS

We retrospectively analyzed data from 794 patients who underwent abdominal surgery between June 2022 and June 2024. Independent risk factors for EA were identified using multivariate logistic regression, which informed the construction of a nomogram model. The dataset was split into a training set (67%) and a validation set (33%), with an additional 119 patients serving as an external validation set. Data analysis was performed using SPSS 26.0 and R 4.3.3, and model performance was assessed using Receiver Operating Characteristic (ROC) and calibration curves.

RESULTS

Multivariate analysis revealed nine independent risk factors for EA: age, ASA classification, type of surgery, duration of surgery, intraoperative fluid volume, use of analgesic pumps, catheter usage, postoperative pain, and smoking history. The model's area under the curve (AUC) was 0.787 in the training set, 0.623 in the validation set, and 0.666 in the external validation set, indicating good predictive performance. Calibration curves demonstrated a strong agreement between predicted and observed outcomes, confirming the model's accuracy and consistency.

CONCLUSION

The developed nomogram integrates multiple risk factors to predict EA risk in abdominal surgery patients. It demonstrates high stability and applicability across different datasets, facilitating early identification of high-risk patients and supporting individualized postoperative management.

Pharmacological and non-pharmacological interventions in patients undergoing nasal surgeries for prevention of emergence agitation: a systematic review and network meta-analysis

BACKGROUND

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.

METHODS

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.

RESULTS

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-1 for 10 minutes as a bolus, followed by 0.4 μg.kg-1.h-1), bilateral nasociliary and maxillary nerve block, ketamine (0.5 mg.kg-1 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.

CONCLUSIONS

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.

Application of Butorphanol versus Sufentanil in Multimode Analgesia via Patient Controlled Intravenous Analgesia After Hepatobiliary Surgery: A Retrospective Cohort Study

Purpose

We investigate the efficacy and safety of butorphanol in multimodal analgesia combined with dexmedetomidine and ketorolac via patient-controlled intravenous analgesia (PCIA) after hepatobiliary surgery, as compared with sufentanil.

Patients and Methods

Postoperative follow-up data of hepatobiliary surgery patients in Henan Provincial People's Hospital from March 2018 to June 2021 were collected retrospectively and divided into butorphanol group (group B) or sufentanil group (group S) according to the postoperative intravenous controlled analgesia scheme. The baseline characteristics and surgical information of the two groups were matched through propensity score matching (PSM).

Results

A total of 3437 patients were screened, and PSM yielded 1816 patients after matching, including 908 in the butorphanol group and 908 in the sufentanil group. Compared with group S, the incidence of moderate-to-severe pain on the first postoperative day and the second postoperative day was lower in group B during rest (3.2% vs 10.9%, P<0.001; 1.2% vs 4.6%, P<0.001), and during movement (7.0% vs 18.9%, P<0.001; 2.6% vs 8.7%, P<0.001). Patients receiving butorphanol had a lower morphine consumption (50mg vs 120mg, P<0.001). The bolus attempts of an analgesic pump in group B were significantly lower than in group S (1 vs 2, P<0.001). Postoperative hospital length of stay was shortened in group B (11d vs 12d, P=0.017). The occurrence of postoperative vomiting was lower in group B (1.4% vs 3.0%, P=0.025) than in group S. However, more patients in group B experienced dizziness (0.9% vs 0.1%, P=0.019).

Conclusion

Compared with sufentanil, the application of butorphanol in multimodal analgesia combined with dexmedetomidine and ketorolac via PCIA ameliorated postoperative pain after hepatobiliary surgery, with reduced opioid consumption and shorter postoperative hospital length of stay.