Anesthetic Management and Deep Sedation After Emergence From General Anesthesia: A Retrospective Cohort Study
Authors' conclusion
Likelihood of deep sedation after recovery increased with intraoperative use of halogenated agents with higher solubility and increased further when propofol was concomitantly used. Patients who experience deep sedation during anesthesia recovery have an increased risk of opioid-induced respiratory complications on general care wards.
Study context
- Population
- Adults undergoing procedures under GA admitted to the PACU, May 2018 to December 2020
- Participants
- 56,275 adults
- Exposure
- Anesthetic regimens and adjuncts vs desflurane without propofol
- Outcome
- Deep sedation (RASS ≤−4, deeply sedated/unarousable) during anesthesia recovery
Methodological detailsmultivariable logistic regression
- Multivariable logistic regression
Main finding
As reported in the abstract
RASS ≤−4
Each group vs desfluraneOdds ratio (95% CI)
Sevoflurane
1.85(1.45–2.37)
Isoflurane
4.21(3.29–5.38)
Desflurane-propofol
2.61(1.99–3.42)
Sevoflurane-propofol
4.20(3.28–5.39)
Isoflurane-propofol
6.39(4.90–8.34)
TIVA
2.98(2.22–3.98)
- Incidence of Richmond Agitation-Sedation Scale (RASS) ≤−4 (2003 patients), cases per 1000 anesthetics
- 35.6 [95% CI, 34.1-37.2]
Observational data: associations, not effects.
Further findings
RASS ≤−4 with adjunct drugs
| OR (95% CI) | ||
|---|---|---|
| Dexmedetomidine | 2.47 (2.10–2.89) | |
| Gabapentinoids | 2.17 (1.90–2.48) | |
| Midazolam | 1.34 (1.21–1.49) | |
| 0.20.5125Odds ratio (log scale) |
Safety
Opioid-induced respiratory complications and naloxone administration on general care wards (deeply sedated patients)
| OR (95% CI) | ||
|---|---|---|
| Deeply sedatedOpioid-induced respiratory complications | 2.59 (1.32–5.10) | |
| Deeply sedatedNaloxone administration | 2.93 (1.42–6.03) | |
| 0.10.31310Odds ratio (log scale) |
Original publication
Anesthetic Management and Deep Sedation After Emergence From General Anesthesia: A Retrospective Cohort Study. Anesth Analg. Published 19 May 2023. doi:10.
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