The Effect of Different Anesthetic Agents on Emergence Agitation in Patients Undergoing Vitreoretinal Surgery - Retrospective Study

Yıl 2026, Cilt: 8 Sayı: 1, 48 - 55, 28.02.2026

Emel Baklaci , Ali Akdoğan , Büşra Köse , Erdem Nail Duman

https://doi.org/10.52827/hititmedj.1749081

https://izlik.org/JA39LX24YC

Öz

Objective: Emergence agitation is a condition occurring in the early recovery phase of general anesthesia, negatively impacting patient comfort. It is particularly relevant in vitreoretinal surgery due to prolonged duration and changes in intraocular pressure. This study retrospectively compares the effects of different inhalation anesthetics on emergence agitation in such cases.
Material and Method: A total of 254 ASA I–III patients who underwent vitreoretinal surgery were included. Based on anesthesia maintenance, patients were divided into two groups: sevoflurane (Group S) and desflurane (Group D). Hemodynamic data, extubation quality score, Richmond Agitation-Sedation Scale (RASS) scores at 0, 15, and 30 minutes, nausea-vomiting, and additional analgesic needs were evaluated from anesthesia records.
Results: No significant differences were found between groups regarding demographics, surgery/anesthesia durations, extubation times, RASS scores, or extubation quality. However, Group D showed significantly higher heart rate at 30 and 60 minutes, and mean arterial pressure at 45 minutes.
Conclusion: The choice of inhalation agent does not significantly impact emergence agitation in vitreoretinal surgery. However, desflurane may lead to increased intraoperative hemodynamic responses compared to sevoflurane.

Anahtar Kelimeler

Anesthesia , Desflurane , Emergence Agitation , Sevoflurane , Vitreoretinal Surgery

Etik Beyan

This study was approved by the Ethics Committee of Karadeniz Technical University, School of Medicine (Decision No: 147, dated 13.07.2023).

Farklı Anestezik Ajanların Vitreoretinal Cerrahi Geçiren Hastalarda Uyanma Agitasyonuna Etkisi - Retrospektif Çalışma

https://izlik.org/JA39LX24YC

Öz

Amaç: Uyanma ajitasyonu, genel anesteziden erken iyileşme döneminde ortaya çıkan ve hasta konforunu olumsuz etkileyen bir durumdur. Özellikle süresi uzun olan ve göz içi basıncında değişikliklere yol açan vitreoretinal cerrahilerde önemli bir klinik sorun teşkil etmektedir. Bu retrospektif çalışmada, farklı inhalasyon anesteziklerinin bu hasta grubunda uyanma ajitasyonu üzerine etkileri karşılaştırılmıştır.
Gereç ve Yöntem: ASA I–III grubu toplam 254 hasta çalışmaya dahil edilmiştir. Anestezi idame yöntemine göre hastalar iki gruba ayrılmıştır: sevofluran (Grup S) ve desfluran (Grup D). Hemodinamik veriler, ekstübasyon kalitesi skoru, 0, 15 ve 30 dakikalarda Richmond Agitasyon-Sedasyon Ölçeği (RASS) skorları, bulantı-kusma ve ek analjezik ihtiyaçlar anestezi kayıtlarından değerlendirildi.
Bulgular: Gruplar arasında demografik özellikler, cerrahi/anestezi süresi, ekstübasyon süresi, RASS skorları ve ekstübasyon kalitesi açısından anlamlı bir fark bulunmamıştır. Ancak, Grup D’de 30. ve 60. dakikalarda kalp hızı ve 45. dakikada ortalama arter basıncı anlamlı derecede yüksek bulunmuştur.
Sonuç: Vitreoretinal cerrahilerde kullanılan inhalasyon ajanlarının uyanma ajitasyonu üzerine belirgin bir etkisi bulunmamaktadır. Bununla birlikte, desfluran kullanımının sevoflurana kıyasla intraoperatif dönemde artmış hemodinamik yanıtlarla ilişkili olabileceği göz önünde bulundurulmalıdır.

Anahtar Kelimeler

Anestezi , Desfluran , Sevofluran , Uyanma Agitasyonu , Vitreoretinal Cerrahi

Etik Beyan

Bu çalışma, Karadeniz Teknik Üniversitesi Tıp Fakültesi Etik Kurulu’nun 13.07.2023 tarihli ve 147 sayılı kararı ile etik açıdan onaylanmıştır.

Kaynakça

• Loriga B, Di Filippo A, Tofani L, et al. Postoperative pain after vitreo-retinal surgery is influenced by surgery duration and anesthesia conduction. Minerva Anestesiol 2019;85(7):731-737.
• Lee SJ, Sung TY. Emergence agitation: current knowledge and unresolved questions. Korean J Anesthesiol 2020;73(6):471-485.
• Kim HJ, Kim DK, Kim HY, Kim JK, Choi SW. Risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery. Clin Exp Otorhinolaryngol 2015;8(1):46-51.
• Farmery AD, Shlugman D, Rahman R, Rosen P. Sub-Tenon's block reduces both intraoperative and postoperative analgesia requirement in vitreo-retinal surgery under general anaesthesia. Eur J Anaesthesiol 2003;20(12):973-978.
• Kucukosman SS, Akdogan A, Uzlu D, Duman EN. Retrospective evaluation of the effects of different anesthesia methods on emergence agitation in patients undergoing vitreoretinal surgery. Cir Cir Published online January 9, 2025.
• Chen J, Shi X, Hu W, et al. Comparing different administration methods of subanaesthetic propofol to mitigate emergence agitation in preschool children undergoing day surgery: a double-blind, randomised controlled study. BMJ Paediatr Open 2025;9(1):e002376.
• Radtke FM, Franck M, Hagemann L, Seeling M, Wernecke KD, Spies CD. Risk factors for inadequate emergence after anesthesia: emergence delirium and hypoactive emergence. Minerva Anestesiol 2010;76(6):394-403.
• Hino M, Mihara T, Miyazaki S, et al. Development and Validation of a Risk Scale for Emergence Agitation After General Anesthesia in Children: A Prospective Observational Study. Anesth Analg 2017;125(2):550-555.
• Cao S, Wang H, Tang L, An G. Comparing Recovery from Desflurane and Sevoflurane in Patients with Different Body Fat Percentages: A Randomized Controlled Trial. Curr Drug Deliv 2024;21(4):623-630.
• Ebert TJ, Muzi M. Sympathetic hyperactivity during desflurane anesthesia in healthy volunteers. A comparison with isoflurane. Anesthesiology 1993;79(3):444-453.
• Gueugniaud PY, Vaudelin G, Bertin-Maghit M, Bouchard C, Stagni R, Petit P. Comparison of the myocardial effects of desflurane and isoflurane in healthy patients: assessment by continuous oesophageal aortic blood flow echo-Doppler. Br J Anaesth 1998;81(6):844-849.
• Patel SS, Goa KL. Desflurane. A review of its pharmacodynamic and pharmacokinetic properties and its efficacy in general anaesthesia. Drugs 1995;50(4):742-767.
• Schraag S, Pradelli L, Alsaleh AJO, et al. Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis. BMC Anesthesiol 2018;18(1):162.
• Yi MS, Kang H, Kim MK, et al. Relationship between the incidence and risk factors of postoperative nausea and vomiting in patients with intravenous patient-controlled analgesia. Asian J Surg 2018;41(4):301-306.
• He J, Zhang Y, Xue R, Lv J, Ding X, Zhang Z. Effect of Desflurane versus Sevoflurane in Pediatric Anesthesia: A Meta-Analysis. J Pharm Pharm Sci 2015;18(2):199-206.
• Menser C, Smith H. Emergence Agitation and Delirium: Considerations for Epidemiology and Routine Monitoring in Pediatric Patients. Local Reg Anesth 2020;13:73-83.
• White PF, Tang J, Wender RH, et al. Desflurane versus sevoflurane for maintenance of outpatient anesthesia: the effect on early versus late recovery and perioperative coughing. Anesth Analg 2009;109(2):387-393.
• Klock PA Jr, Czeslick EG, Klafta JM, Ovassapian A, Moss J. The effect of sevoflurane and desflurane on upper airway reactivity. Anesthesiology 2001;94(6):963-967.
• White PF, Eshima RW, Maurer A, et al. A comparison of airway responses during desflurane and sevoflurane administration via a laryngeal mask airway for maintenance of anesthesia. Anesth Analg 2003;96(3):701-705.