Remifentanil is Superior to Propofol for Treating Emergence Agitation in Adults After General Anesthesia

Background: Emergence agitation (EA) is one of the most common complications in clinical general anesthesia during recovery in adults. Remifentanil and propofol can reduce the incidence of EA, but with no randomized controlled trial to evaluate their effectiveness for treating EA. This study aims to compare the effectiveness of remifentanil and propofol for treating EA following general anesthesia. Patients and methods: Among 152 randomized patients with a mean of 49.5 years, and 99 (65.1%) of them being male, 149 were divided into two groups for subsequent analysis. The remifentanil group (Group R, n = 74) received a 0.5μg kg – 1 remifentanil infusion followed by a 0.05μg kg – 1 min – 1 infusion until 15 minutes, after the onset of agitation. The propofol group (Group P, n = 75) received a 1mg kg – 1 propofol infusion once agitation occurred. Emergence agitation was assessed using the Riker Sedation Agitation Score, with a score of ≥ 5 defining emergence agitation. During the post–anesthesia care unit (PACU), the recurrence of emergence agitation, time to extubation, and discharge from PACU were evaluated. Results: The incidence of reoccurring emergence agitation was lower in Group R (29.7%) compared with Group P (49.3%), with an odds ratio of 0.44 (95% CI 0.22– 0.85; P =0.014). The time to extubation was shorter in Group R (mean 12min, range 8– 15 min) compared with Group P (mean 17min, range 13– 21 min) ( P < 0.001), as was the time discharge from the PACU (mean 30.5 min, range 25– 40 min) vs Group P (mean 37.5 min, range 31– 50 min) ( P =0.001). Conclusion: Treatment of emergence agitation in adults with remifentanil infusion is more effective than propofol, with a shorter time to extubation and discharge from PACU. Keywords: anesthesia, emergence agitation, remifentanil, propofol