Factors influencing agitation during anesthesia recovery after laparoscopic hernia repair under total inhalation combined with caudal block anesthesia

Table 1 Sedation-agitation scale definitions

Classification	Point	Description
Unable to wake up	1	The patient has little or no response to harmful stimuli, does not communicate, or does not follow instructions
Very calm	2	Patients respond to physical stimuli but cannot communicate or follow commands and may move spontaneously
Calm	3	The patient is awakened by verbal stimulation or slight shaking, but falls asleep again; follow simple instructions
Cool fit	4	The patient is calm, wakes easily, and follows instructions
EA	5	The patient is anxious or mildly agitated and tries to sit up and calm down on verbal instructions
Moderate EA	6	The patient is not calm, despite the doctor’s frequent verbal reminders of limitations; the patient needs to be physically restrained and bite the tracheal catheter
Severe EA	7	Patients pulled tracheal tubes, tried to remove them, climbed over bed bars, hit staff, convulsed back to back

EA: Emergence agitation.

Table 2 Comparison of patient characteristics between the two groups

	EA (n = 72)	Non-EA (n = 228)	χ2/Z	P value
Gender
Male/female	45/27	89/139	12.190	< 0.001
Age (year)	38 (36, 40)	39 (34, 43)	-1.413	0.158
Body mass index (kg/m2)	23.43 (22.01, 25.03)	23.36 (21.84, 25.19)	-0.372	0.710
Hypertension	11 (15.28)	54 (23.68)	2.278	0.131
Diabetes	13 (18.06)	58 (25.44)	1.651	0.199
Smoking	27 (37.50)	60 (26.32)	3.324	0.068
ASA classification
I	11 (15.28)	71 (31.14)	-3.068	0.002
II	52 (72.22)	145 (63.60)
III	9 (12.50)	12 (5.26)
Preoperative anxiety	59 (81.94)	81 (35.53)	47.371	< 0.001
Preoperative fasting duration (hours)
Solid food	7.45 (6.95, 7.80)	6.90 (6.60, 7.20)	-7.045	< 0.001
Clear liquid food	3.30 (2.93, 3.50)	2.85 (2.60, 3.20)	-5.709	< 0.001
Intraoperative hypothermia	35 (48.61)	63 (27.63)	10.950	0.001
Intraoperative blood loss (mL)	11 (10, 12)	11 (9, 12)	-0.128	0.898
Operation time (minutes)	41.00 (37.00, 44.00)	40.00 (36.00, 44.75)	-0.525	0.600
Indwelling catheter	44 (61.11)	82 (35.96)	14.204	< 0.001
Pain degree during recovery	6 (6, 7)	5 (4, 6)	-7.901	< 0.001

ASA: American Society of Anesthesiologists; EA: Emergence agitation.

Table 3 Multivariate logistic regression analysis

Variable	β	SE	P value	OR	95%CI
ASA classification	0.935	0.405	0.021	6.487	1.328-31.671
Preoperative anxiety	2.591	0.508	< 0.001	13.340	4.929-36.101
Duration of solid food fasting	2.259	0.490	< 0.001	4.860	2.482-9.515
Duration of clear fluid fasting	2.119	0.564	< 0.001	4.408	2.035-9.551
Indwelling catheter	0.968	0.444	0.029	2.633	1.103-6.287
Pain degree during recovery	1.172	0.228	< 0.001	10.430	4.268-25.488

ASA: American Society of Anesthesiologists; OR: Odds ratio; CI: Confidence interval.

Table 4 External validation of the risk nomogram for emergence agitation in patients undergoing laparoscopic hernia based solely on aspiration combined with sacral block anesthesia

Models	Reality	Prediction		Total
		EA	Non-EA
Nomogram	EA	10	2	12
	Non-EA	5	33	38
	Total	15	35	50
Random forest	EA	9	3	12
	Non-EA	6	30	38
	Total	17	33	50

EA: Emergence agitation.