Influence of Postoperative Indwelling Urethral Catheter on Emergence Agitation of Patients with Thoracic Surgery: A Prospective Cohort Study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHAOJin-lan ¹ , QIUZhu-ting ¹ , XUNing-hui ¹ , GONGRen-rong ¹ , YANGMei ² , LIWei-min ³ ,  CHEGuo-wei ²

1. Department of Operation Room of West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
2. Department of Thoracic Surgery of West China Hospital, Sichuan University, Chengdu 610041, P.R.China;
3. Department of Respiratory Medicine of West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding author：

CHEGuo-wei, Email: guowei_che@yahoo.com

Keywords：

Thoracic surgery; Indwelling catheter; Emergence agitation; Adverse events

DOI：

10.7507/1007-4848.20160075

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Objective To explore the emergence agitation resulting from postoperative indwelling urethral catheters in patients of thoracic surgery. Methods In this prospective cohort study, we recruited 140 patients who were scheduled for thoracic surgery under general anesthesia in West China Hospital from January through April 2014. These patients were divided into two groups including a control group and a trial group with 70 patients in each group. The patients in the control group had indwelled urethral catheter routinely. The catheter removed after the surgery at operation room in the trial group. Intraoperative urinary volume, emergence agitation (EA) occurrence, postoperative urinary retention, and urethral irritation were recorded. Results There was no statistical difference in postoperative urinary retention rate between the control group and the trial group (1.43% vs. 2.86%, P=0.230). However, the urethral irritation rate in the control group was significantly higher than that in the trial group (12.86% vs. 0.00%, P=0.012) . And there was a statistical difference in adverse event rate (2.86% vs. 0.00%, P=0.039) between the two groups. There was a significantly higher incidence of urethral irritation in male patients (20.51%, 8/39) than female patients (3.23%, 1/31, P=0.033).The rate of EA in the control group was significantly higher than that in the trial group (28.57% vs. 12.86%, P=0.010). There was a significantly higher EA rate in the patients who had urethral irritation by postoperative indwelling catheters compared with those without indwelling catheters (45.00% vs. 12.86%, P=0.043). Conclusion This study suggests that postoperative EA is a result from urethral irritation than local pain, and the EA rate can be decreased by removal of catheter before anaesthetic recovery.

Citation： ZHAOJin-lan, QIUZhu-ting, XUNing-hui, GONGRen-rong, YANGMei, LIWei-min, CHEGuo-wei. Influence of Postoperative Indwelling Urethral Catheter on Emergence Agitation of Patients with Thoracic Surgery: A Prospective Cohort Study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(4): 319-322. doi: 10.7507/1007-4848.20160075 Copy

1.	Yu D, Chai W, Sun X, et al. Emergence agitation in adults: risk factors in 2,000 patients. Can J Anaesth, 2010, 57(9): 843-848.
2.	Kim YS, Chae YK, Choi YS, et al. A comparative study of emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture. Korean J Anesthesiol, 2012, 63(1): 48-53.
3.	钟宝琳, 李优春, 黄桂明. 成人全身麻醉苏醒期躁动相关因素回顾性分析. 现代预防医学, 2012, 39(11): 2858-2862.
4.	刘新. 539例全身麻醉手术患者苏醒期躁动原因分析及护理. 中华护理杂志, 2007, 42(10): 886-888.
5.	陈荣珠, 董明, 李成太, 等. 手术室护理干预对胸科手术苏醒期躁动程度的影响. 全科护理, 2011, 9(11): 3041-3042.
6.	Bjerregaard LS, Bagi P, Kehlet H. Postoperative urinary retention (POUR) in fast-track total hip and knee arthroplasty. Acta Orthop, 2014, 85(1): 8-10.
7.	Souto CA, Rhoden EL, De Conti R, et al. Urethral catheter removal 7 or 14 days after radical retropubic prostatectomy: clinical implications and complications in a randomized study. Rev Hosp Clin Fac Med Sao Paulo, 2004, 59(5): 262-265.
8.	Feneley RC, Hopley IB, Wells PN. Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol, 2015, 39(8): 459-470.
9.	Nicolle LE. Urinary catheter-associated infections. Infect Dis Clin North Am, 2012, 26(1): 13-27.
10.	Stallard S, Prescott S. Postoperative urinary retention in general surgical patients. Br J Surg, 1988, 75(11): 1141-1143.
11.	Blodgett TJ, Gardner SE, Blodgett NP, et al. A tool to assess the signs and symptoms of catheter-associated urinary tract infection: development and reliability. Clin Nurs Res, 2015, 24(4): 341-356.
12.	Hollingsworth JM, Rogers MA, Krein SL, et al. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med, 2013, 159(6): 401-410.
13.	Knoll BM, Wright D, Ellingson L, et al. Reduction of inappropriate urinary catheter use at a Veterans Affairs hospital through a multifaceted quality improvement project. Clin Infect Dis, 2011, 52(11): 1283-1290.
14.	Nanavati AJ, Prabhakar S. Fast-track surgery: Toward comprehensive peri-operative care. Anesth Essays Res, 2014, 8(2): 127-133.
15.	倪新莉, 涂继善. 全身麻醉苏醒期患者躁动原因调查分析. 临床麻醉学杂志, 2001, 2(17): 100.
16.	Kamdar A, Yahya A, Thangaraj L. Retrospective observational study of the incidence of short-term indwelling urinary catheters in elderly patients with neck of femur fractures. Geriatr Gerontol Int, 2009, 9(2): 131-134.
17.	Bjerregaard LS, Bagi P, Kehlet H. Postoperative urinary retention (POUR) in fast-track total hip and knee arthroplasty. Acta Orthop, 2014, 85(1): 8-10.
18.	Jouve P, Bazin JE, Petit A, et al. Epidural versus continuous preperitoneal analgesia during fast-track open colorectal surgery: a randomized controlled trial. Anesthesiology, 2013, 118(3): 622-630.
19.	Talcott JA, Manola J, Chen RC, et al. Using patient-reported outcomes to assess and improve prostate cancer brachytherapy. BJU Int, 2014, 114(4): 511-516.
20.	Greer SF, Sethi AK, Hecker MT, et al. Survey of patients' knowledge and opinions regarding the use of indwelling urinary catheters. Infect Control Hosp Epidemiol, 2011, 32(2): 174-176.
21.	邱舫, 杨梅, 王维, 等. 肺叶切除术后患者无尿管留置的前瞻性队列研究. 中国胸心血管外科临床杂志, 2015, 22(7): 634-637.

1. Yu D, Chai W, Sun X, et al. Emergence agitation in adults: risk factors in 2,000 patients. Can J Anaesth, 2010, 57(9): 843-848.
2. Kim YS, Chae YK, Choi YS, et al. A comparative study of emergence agitation between sevoflurane and propofol anesthesia in adults after closed reduction of nasal bone fracture. Korean J Anesthesiol, 2012, 63(1): 48-53.
3. 钟宝琳, 李优春, 黄桂明. 成人全身麻醉苏醒期躁动相关因素回顾性分析. 现代预防医学, 2012, 39(11): 2858-2862.
4. 刘新. 539例全身麻醉手术患者苏醒期躁动原因分析及护理. 中华护理杂志, 2007, 42(10): 886-888.
5. 陈荣珠, 董明, 李成太, 等. 手术室护理干预对胸科手术苏醒期躁动程度的影响. 全科护理, 2011, 9(11): 3041-3042.
6. Bjerregaard LS, Bagi P, Kehlet H. Postoperative urinary retention (POUR) in fast-track total hip and knee arthroplasty. Acta Orthop, 2014, 85(1): 8-10.
7. Souto CA, Rhoden EL, De Conti R, et al. Urethral catheter removal 7 or 14 days after radical retropubic prostatectomy: clinical implications and complications in a randomized study. Rev Hosp Clin Fac Med Sao Paulo, 2004, 59(5): 262-265.
8. Feneley RC, Hopley IB, Wells PN. Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol, 2015, 39(8): 459-470.
9. Nicolle LE. Urinary catheter-associated infections. Infect Dis Clin North Am, 2012, 26(1): 13-27.
10. Stallard S, Prescott S. Postoperative urinary retention in general surgical patients. Br J Surg, 1988, 75(11): 1141-1143.
11. Blodgett TJ, Gardner SE, Blodgett NP, et al. A tool to assess the signs and symptoms of catheter-associated urinary tract infection: development and reliability. Clin Nurs Res, 2015, 24(4): 341-356.
12. Hollingsworth JM, Rogers MA, Krein SL, et al. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med, 2013, 159(6): 401-410.
13. Knoll BM, Wright D, Ellingson L, et al. Reduction of inappropriate urinary catheter use at a Veterans Affairs hospital through a multifaceted quality improvement project. Clin Infect Dis, 2011, 52(11): 1283-1290.
14. Nanavati AJ, Prabhakar S. Fast-track surgery: Toward comprehensive peri-operative care. Anesth Essays Res, 2014, 8(2): 127-133.
15. 倪新莉, 涂继善. 全身麻醉苏醒期患者躁动原因调查分析. 临床麻醉学杂志, 2001, 2(17): 100.
16. Kamdar A, Yahya A, Thangaraj L. Retrospective observational study of the incidence of short-term indwelling urinary catheters in elderly patients with neck of femur fractures. Geriatr Gerontol Int, 2009, 9(2): 131-134.
17. Bjerregaard LS, Bagi P, Kehlet H. Postoperative urinary retention (POUR) in fast-track total hip and knee arthroplasty. Acta Orthop, 2014, 85(1): 8-10.
18. Jouve P, Bazin JE, Petit A, et al. Epidural versus continuous preperitoneal analgesia during fast-track open colorectal surgery: a randomized controlled trial. Anesthesiology, 2013, 118(3): 622-630.
19. Talcott JA, Manola J, Chen RC, et al. Using patient-reported outcomes to assess and improve prostate cancer brachytherapy. BJU Int, 2014, 114(4): 511-516.
20. Greer SF, Sethi AK, Hecker MT, et al. Survey of patients' knowledge and opinions regarding the use of indwelling urinary catheters. Infect Control Hosp Epidemiol, 2011, 32(2): 174-176.
21. 邱舫, 杨梅, 王维, 等. 肺叶切除术后患者无尿管留置的前瞻性队列研究. 中国胸心血管外科临床杂志, 2015, 22(7): 634-637.

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Influence of Postoperative Indwelling Urethral Catheter on Emergence Agitation of Patients with Thoracic Surgery: A Prospective Cohort Study

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