The effect of the use of subanesthetic dose of propofol before extubation in aesthetic nose surgery on recovery from anesthesia, awakening agitiation and patient satisfaction

Aim: Rhinoplasty is one of the most common surgical procedures performed for functional or aesthetic purposes. One of the most frequent complications of general anesthesia in this operation is emergence agitation. During the emergence phase, patients often experience a sense of suffocation due to swelling, secretions, or the obstructive sensation caused by nasal packing, which can trigger agitation. Additionally, reducing postoperative edema and ecchymosis facilitates quicker recovery and easier reintegration into social life. Managing these complications is critical for enhancing patient comfort and improving aesthetic outcomes. In addition to physical methods, pharmacological agents are commonly used to reduce swelling. Agents such as corticosteroids, anti-inflammatory drugs, and propofol are preferred for this purpose. Propofol, frequently used in general anesthesia for its sedative effects, may have beneficial effects on emergence agitation. However, the literature on this subject is limited. This study aims to investigate the effects of subanesthetic doses of propofol administered before extubation on emergence agitation and patient satisfaction in patients undergoing rhinoplasty. Materials and Methods: The study was conducted at Dursun Odabaş Medical Center on a total of 80 patients scheduled for open rhinoplasty by the Plastic Surgery Department. Patients were classified as ASA I-II, aged between 18 and 65 years, and had no respiratory infections. After obtaining written informed consent, patients were randomly divided into two groups: • Group P (n=40): Received 0.5 mg/kg of 1% propofol intravenously 10 minutes before the end of the surgery. • Group S (n=40): Received 5 ml of 0.9% saline intravenously. All patients were premedicated with 0.05 mg/kg midazolam before being brought to the operating room. General anesthesia induction included 2 µg/kg fentanyl, 1 mg/kg lidocaine, 2 mg/kg propofol, and 0.6 mg/kg rocuronium. Maintenance of anesthesia was achieved using sevoflurane (1 MAC) with 40% oxygen + 60% dry air. Mean arterial pressure (MAP), heart rate (HR), SpO2, and EtCO2 were recorded at baseline and intraoperatively (at 0, 5, 10, 15, 20, 30, 45, 60, and 75 minutes after surgical incision, at the end of surgery, and after extubation). Emergence agitation was assessed using the Ramsey Sedation Scale (RSS) and Patient Satisfaction Scale post-extubation. For postoperative analgesia, 50 mg tramadol and 1 g paracetamol were administered intravenously. Results: A total of 80 patients (46 females and 34 males, mean age 26.8±7.4 years) were included in the study. The VAS scores and agitation severity in Group P were significantly lower (p<0.05) than in Group S. Recovery time was significantly longer (p<0.05) in Group P compared to the saline group. The incidence of head shaking and hand-arm movements at 1 and 5 minutes postoperatively was significantly lower (p<0.05) in the propofol group than in the saline group. No significant difference (p>0.05) was found between the two groups regarding nausea and vomiting at 1 and 5 minutes postoperatively. Patient satisfaction was significantly higher (p<0.05) in the propofol group. In Group P, the proportion of patients who were calm, cooperative, and oriented was significantly higher (p<0.05), while the proportion of patients who were nervous, agitated, and/or restless was significantly lower compared to Group S. These results demonstrate the effectiveness of propofol in reducing emergence agitation. Conclusion: Administration of subanesthetic doses of propofol before extubation reduced emergence agitation, improved patient satisfaction, and enhanced the recovery process after rhinoplasty. The findings suggest that this approach could be adopted as a standard practice for rhinoplasty patients. This method enhances postoperative comfort without increasing the risk of complications. Keywords: Propofol, agitation, rhinoplasty