Prophylactic administration of diphenhydramine/paracetamol reduced emergence agitation and postoperative pain following maxillofacial surgeries: a randomized controlled trial.
Acute pain
Diphenhydramine
Emergence agitation
General anesthesia
Maxillofacial surgery
Journal
European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
ISSN: 1434-4726
Titre abrégé: Eur Arch Otorhinolaryngol
Pays: Germany
ID NLM: 9002937
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
received:
25
04
2021
accepted:
22
05
2021
pubmed:
28
5
2021
medline:
9
3
2022
entrez:
27
5
2021
Statut:
ppublish
Résumé
Emergence agitation after maxillofacial surgeries is an anxious and problematic complication for the surgeon and anesthesiologist that may lead to self-extubation, haemorrhage, and surgical destruction. In this study, we investigated the effects of preemptive administration of diphenhydramine on emergence agitation and quality of recovery after maxillofacial surgery in adult patients. Eighty-five patients undergoing maxillofacial surgery were randomized into two groups. The diphenhydramine group (Group D, n = 40) received diphenhydramine premedication 0.5 mg/kg before anesthesia induction, while the control group (Group C, n = 40) received volume-matched normal saline as a placebo. Before incision, all patients receive 0.1 mg/kg morphine sulfate slowly intravenously within 5 min. Continuous infusion of remifentanil 0.2 μg/kg/h and inhalation of isoflurane was maintained during the anesthesia period. Paracetamol 1 g was infused 15 min before extubation. We evaluated the incidence of agitation during the extubation period after general anesthesia, hemodynamic parameters, and recovery characteristics during the postoperative period. During extubation time, the incidence of emergence agitation was lower in Group D than in Group C (16% vs. 49%, P = 0.041). The time from isoflurane discontinuation to extubation (7.7 min in Group D vs. 6.8 min in Group C, P = 0.082) was not different. Grade of cough during emergence, the severity of pain, analgesic requirements, and hemodynamic changes were lower in group D compared with Group C. Preemptive administration of diphenhydramine provided smooth emergence from anesthesia. It also improved the quality of recovery after maxillofacial surgery. This study was registered at http://irct.ir (registration number IRCT20130304012695N3).
Sections du résumé
BACKGROUND
BACKGROUND
Emergence agitation after maxillofacial surgeries is an anxious and problematic complication for the surgeon and anesthesiologist that may lead to self-extubation, haemorrhage, and surgical destruction. In this study, we investigated the effects of preemptive administration of diphenhydramine on emergence agitation and quality of recovery after maxillofacial surgery in adult patients.
METHODS
METHODS
Eighty-five patients undergoing maxillofacial surgery were randomized into two groups. The diphenhydramine group (Group D, n = 40) received diphenhydramine premedication 0.5 mg/kg before anesthesia induction, while the control group (Group C, n = 40) received volume-matched normal saline as a placebo. Before incision, all patients receive 0.1 mg/kg morphine sulfate slowly intravenously within 5 min. Continuous infusion of remifentanil 0.2 μg/kg/h and inhalation of isoflurane was maintained during the anesthesia period. Paracetamol 1 g was infused 15 min before extubation. We evaluated the incidence of agitation during the extubation period after general anesthesia, hemodynamic parameters, and recovery characteristics during the postoperative period.
RESULTS
RESULTS
During extubation time, the incidence of emergence agitation was lower in Group D than in Group C (16% vs. 49%, P = 0.041). The time from isoflurane discontinuation to extubation (7.7 min in Group D vs. 6.8 min in Group C, P = 0.082) was not different. Grade of cough during emergence, the severity of pain, analgesic requirements, and hemodynamic changes were lower in group D compared with Group C.
CONCLUSIONS
CONCLUSIONS
Preemptive administration of diphenhydramine provided smooth emergence from anesthesia. It also improved the quality of recovery after maxillofacial surgery.
TRIAL REGISTRATION NUMBER
BACKGROUND
This study was registered at http://irct.ir (registration number IRCT20130304012695N3).
Identifiants
pubmed: 34043064
doi: 10.1007/s00405-021-06904-4
pii: 10.1007/s00405-021-06904-4
doi:
Substances chimiques
Acetaminophen
362O9ITL9D
Dexmedetomidine
67VB76HONO
Diphenhydramine
8GTS82S83M
Banques de données
IRCT
['IRCT20130304012695N3']
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
1467-1471Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Fields A, Huang J, Schroeder D, Sprung J, Weingarten T (2018) Agitation in adults in the post-anesthesia care unit after general anesthesia. Br J Anesth 121(5):1052–1058
doi: 10.1016/j.bja.2018.07.017
Ham SY, Kim JE, Park C, Shin MJ, Shim YH (2014) Dexmedetomidine does not reduce emergence agitation in adults following orthognathic surgery. Acta Anaesthesiol Scand 58(8):955–960
doi: 10.1111/aas.12379
Polat R, Peker K, Baran I, Aydın GB, Gülöksüz ÇT, Dönmez A (2015) Comparison between dexmedetomidine and remifentanil infusion in emergence agitation during recovery after nasal surgery. Anaesthesist 64(10):740–746
doi: 10.1007/s00101-015-0077-8
Lee SJ, Choi SJ, In CB, Sung TY (2019) Effects of tramadol on emergence agitation after general anesthesia for nasal surgery: a retrospective cohort study. Medicine 98(10):e14763
doi: 10.1097/MD.0000000000014763
Church DS, Church MK (2011) Pharmacology of antihistamines. World Allergy Organ J 4(3 Suppl):S22–S27
doi: 10.1186/1939-4551-4-S3-S22
Li YY, Zeng YS, Chen JY, Wang KF, Hsing CH, Wu WJ, Wang JJ, Feng PH, Chu CC (2019) Prophylactic diphenhydramine attenuates postoperative catheter-related bladder discomfort in patients undergoing gynecologic laparoscopic surgery: a randomized double-blind clinical study. J Anesth 20:1–6
Yu D, Chai W, Sun X, Yao L (2010) Emergence agitation in adults: risk factors in 2,000 patients. Can J Anesth 57(9):843–848
doi: 10.1007/s12630-010-9338-9
Kim HJ, Kim DK, Kim HY, Kim JK, Choi SW (2015) Risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery. Clin Exp Otorhinolaryngol 8(1):46–51
doi: 10.3342/ceo.2015.8.1.46
Jo JY, Jung KW, Kim HJ, Park SU, Park H, Ku S, Choi SS (2019) Effect of total intravenous anesthesia vs volatile induction with maintenance anesthesia on emergence agitation after nasal surgery: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg 145(2):117–123
doi: 10.1001/jamaoto.2018.3097
Khajavi MR, Bahari S, Moharari RS, Pourfakhr P, Etezadi F, Imani F (2018) The clinical effect of oral gabapentin/clonidine premedication on postoperative outcomes in patients undergoing orthognathic surgery. Arch Anesthesiol Crit Care 4(2):455–458
Pourfakhr P, Ziaei SH, Etezadi F, Khajavi MR, Sharifnia MR (2019) Diphenhydramine definitely suppresses fentanyl-induced cough during general anesthesia induction: a double-blind, randomized, and placebo-controlled study. Acta Med Iran 30:316–319
Ghossein N, Lakhkar AD (2020) Anticholinergic medications. InStatPearls [Internet] 2020 Apr 11. Stat Pearls Publishing