Abstract
Background
Postoperative emergency agitation (EA) is a common problem. Dexmedetomidine and remifentanil may be used to prevent this problem. Our primary aim was to compare dexmedetomidine, remifentanil, and placebo with respect to their effectiveness in preventing postoperative EA.
Material and methods
Ninety patients undergoing nasal surgery were randomized into three groups. The dexmedetomidine group (group D, n = 30) received dexmedetomidine infusion at a rate of 0.4 μg kg–1 h−1; the remifentanil group (group R, n = 30) received remifentanil infusion at a rate of 0.05 μg kg–1 min−1 from induction of anesthesia until extubation; and the control group (group S, n = 30) received a volume-matched normal saline infusion as a placebo. Propofol (1.5–2 mg kg−1) and fentanyl (1 μg kg−1) were used to initiate anesthesia, and desflurane was used to maintain anesthesia. The incidence of agitation, hemodynamic parameters, and recovery characteristics were evaluated during emergence.
Results
The incidence of EA was significantly higher in group S (46.7 %) compared with groups R and D (3.3 and 20 %, respectively; p < 0.001). The lowest incidence of EA was detected in group R (p = 0.046). Residual sedation in the post-anesthesia care unit (PACU) was similar in all groups (p = 0.947). The incidence of nausea or vomiting was significantly lower in group D than in groups R and S (p = 0.043). Administration of analgesics in the PACU was higher in group R than in groups S and D (p = 0.015).
Conclusion
Anesthetic maintenance with either remifentanil or dexmedetomidine infusion until extubation provided a more smooth and hemodynamically stable emergence, without complications after nasal surgery. While remifentanil was superior to dexmedetomidine with regard to avoiding EA, dexmedetomidine was more effective than remifentanil regarding vomiting and pain.
Zusammenfassung
Hintergrund
Unser vorrangiges Ziel war es, Dexmedetomidin, Remifentanil und Placebo im Hinblick auf ihre Wirksamkeit bei der Verhinderung postoperativer Erregungszustände zu vergleichen.
Methode
Neunzig Patienten, die sich einer Nasenoperation unterzogen hatten, wurden in 3 Gruppen eingeteilt. Die Dexmedetomidingruppe (Gruppe D) erhielt eine Dexmedetomidininfusion in einer Konzentration von 0,4 μg kg−1 h−1, die Remifentanilgruppe (Gruppe R) erhielt eine Remifentanilinfusion in einer Konzentration von 0,05 μg kg−1 min−1, beginnend mit der Narkoseeinleitung bis zur Extubation, und die Kontrollgruppe (Gruppe S) erhielt eine volumengleiche normale NaCl-Infusion als Placebo. Die Inzidenz der Agitation, hämodynamische Parameter und das Aufwachverhalten wurden ausgewertet.
Ergebnisse
Die Inzidenz postoperativer Erregungszustände war in der Gruppe S im Vergleich zu den Gruppen R und D (p = 0,000) signifikant höher. Die niedrigste Inzidenz wurde in der Gruppe R (p = 0,046) festgestellt. Die residuale Sedierung im Aufwachraum (AWR) war in allen Gruppen ähnlich (p = 0,947). Die Häufigkeit von Übelkeit oder Erbrechen war in Gruppe D deutlich niedriger als in der Gruppe R und S (p = 0,043). Die Verabreichung von Schmerzmitteln im AWR war in der Gruppe R höher als in den Gruppen S und D (p = 0,015).
Schlussfolgerung
Die Narkoseausleitung entweder mit Remifentanil oder Dexmedtomidininfusion bis zur Extubation ermöglicht eine ruhigere, hämodynamisch stabilere und komplikationsärmere Aufwachphase im Vergleich zu einer NaCl-Infusion nach einer Nasenoperation. Obwohl postoperative Erregungszustände unter Remifentanilinfusion seltener auftraten als unter Dexmedetomidininfusion, erwies sich Dexmedetomidin gegenüber Remifentanil als überlegen bezüglich postoperativem Erbrechen und Schmerz.
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Change history
26 April 2023
An Editorial Expression of Concern to this paper has been published: https://doi.org/10.1007/s00101-023-01294-0
20 December 2023
This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1007/s00101-023-01373-2
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R. Polat, K. Peker, I. Baran, G. Bumin Aydin, Ç. Topçu Gülöksüz, and A. Dönmez state that there are no conflicts of interest.
All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.
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This article has been retracted. Please see the retraction notice for more detail:https://doi.org/10.1007/s00101-023-01373-2
The article to which this update relates has been retracted. Please see the retraction notice for more detail: https://doi.org/10.1007/s00101-023-01373-2
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Polat, R., Peker, K., Baran, I. et al. RETRACTED ARTICLE: Comparison between dexmedetomidine and remifentanil infusion in emergence agitation during recovery after nasal surgery. Anaesthesist 64, 740–746 (2015). https://doi.org/10.1007/s00101-015-0077-8
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DOI: https://doi.org/10.1007/s00101-015-0077-8