Risk Factors for Emergence Agitation in Adults Undergoing Thoracoscopic Lung Surgery: A Case-Control Study of 1,950 Patients

ABSTRACT Objective : To investigate the incidence of and risk factors for emergence agitation (EA) in adult patients after thoracoscopic lung surgery. Design : A retrospective case-control study. Setting : Single-center university hospital. Participants : 1950 adult patients with elective lung surgery from January to December 2016. Interventions : None. Measurements and Main Results : Preoperative, operative and anesthesia-related data were collected. EA was assessed by the Riker Sedation-Agitation Scale and defined as a Riker score ≥ 5. Univariate analyses and multivariable logistic regression analysis were used to identify risk factors for EA. The incidence of EA was 14.1%. The results of the multivariate analysis showed that male sex (OR: 1.877, 95% CI: 1.341-2.627), age ≥65 years (OR: 1.424, 95% CI: 1.074-1.889), BMI ≥24 kg m−2 (OR: 1.409, 95% CI: 1.070-1.856), ASA Ⅲ or Ⅳ (OR: 2.654, 95% CI: 1.189-5.924), cigarette smoking (OR: 1.553, 95% CI: 1.108-2.177), the duration of surgery (OR: 1.006, 95% CI: 1.003-1.009), intraoperative tachycardia (OR: 1.721, 95% CI: 1.058-2.802), intraoperative hypotension (OR: 1.636, 95% CI: 1.064-2.514), intraoperative hypertension (OR: 1.608; 95% CI: 1.056-2.448) and rescue analgesia (OR: 1.810, 95% CI: 1.235-2.653) were independent risk factors for EA. However, wound infiltration (OR: 0.679, 95% CI: 0.507-0.908) and the use of dexmedetomidine (OR: 0.663, 95% CI: 0.490-0.869) appeared to be protective factors against EA. Conclusion : EA is a common complication after thoracoscopic lung surgery, especially within a certain population. Adequate perioperative management, which comprises wound infiltration, the maintenance of intraoperative hemodynamic stability, sufficient analgesia and the use of dexmedetomidine, should be adopted to reduce the incidence of EA.