A comparative study To evaluate the effect of remifentanil based TIVA versus balanced anaesthesia on emergence agitation in patients undergoing nasal surgeries.

Emergence agitation is an acute, self-limited and non-fluctuating state of psychomotor excitement. This hyperactive state is confined to the emergence period after general anaesthesia  Although the incidence rate of EA in adults range from 0.25% to 21.3% and time of onset typically lasts for about 15 min serious consequences can occur if patients with EA are not treated promptly. Emergence agitation can lead to serious consequences such as self-extubation, removal of catheters, haemorrhage, and even severe injuries from falling out of the bed. Furthermore, it may increase the demand on human resources and cause medical staff injuries . While its pathogenesis remains unclear, previous studies reported that ENT (ear, nose, and throat) surgical procedures have a higher incidence of emergence agitation in both adults and children. Various drugs and techniques have been proven effective in reducing the incidence of emergence agitation. Despite decades of research, studies on the occurrence rate, risk factors and prevention of emergence agitation in adult patients are still ongoing. In particular, opinions differ on the different effects of inhalation and intravenous anaesthesia. In prospective study of 1359 adult patients multivariate analysis showed that the method of anaesthesia did not affect occurrence of emergence agitation . Another prospective observational study of about 2000 adults reported that the use of volatile anaesthetic agents was associated with a higher occurrence rate of emergence agitation . Therefore the current study is designed to compare two standard techniques of anaesthesia that is remifentanil based TIVA versus balanced anaesthesia on emergence agitation.