Postoperative agitation frequently occurs after
general anesthesia and may be associated with serious consequences. However, studies in neurosurgical patients have been inadequate. We aimed to investigate the incidence and risk factors for early postoperative agitation in patients after
craniotomy, specifically focusing on the association between postoperative
pneumocephalus and agitation. Adult intensive care unit admitted patients after elective
craniotomy under
general anesthesia were consecutively enrolled. Patients were assessed using the Sedation-Agitation Scale during the first 24 hours after operation. The patients were divided into two groups based on their maximal Sedation-Agitation Scale: the agitation (Sedation-Agitation Scale ≥ 5) and non-agitation groups (Sedation-Agitation Scale ≤ 4). Preoperative baseline data, intraoperative and intensive care unit admission data were recorded and analyzed. Each patient's computed tomography scan obtained within six hours after operation was retrospectively reviewed. Modified Rankin Scale and hospital
length of stay after the surgery were also collected. Of the 400 enrolled patients, agitation occurred in 13.0% (95% confidential interval: 9.7-16.3%). Body mass index, total
intravenous anesthesia, intraoperative fluid intake, intraoperative
bleeding and transfusion, consciousness after operation, endotracheal intubation kept at intensive care unit admission and
mechanical ventilation,
hyperglycemia without a history of diabetes, self-reported
pain and postoperative bi-frontal
pneumocephalus were used to build a multivariable model. Bi-frontal
pneumocephalus and delayed extubation after the operation were identified as independent risk factors for postoperative agitation. After adjustment for confounding, postoperative agitation was independently associated with worse neurologic outcome (odd ratio: 5.4, 95% confidential interval: 1.1-28.9, P = 0.048). Our results showed that early postoperative agitation was prevalent among post-
craniotomy patients and was associated with adverse outcomes. Improvements in clinical strategies relevant to bi-frontal
pneumocephalus should be considered.
TRIAL REGISTRATION: ClinicalTrials.gov (NCT02318199).