{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T20:40:07Z","timestamp":1772916007180,"version":"3.50.1"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,12,1]],"date-time":"2019-12-01T00:00:00Z","timestamp":1575158400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,12,16]],"date-time":"2019-12-16T00:00:00Z","timestamp":1576454400000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Anesthesiol"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Sugammadex allows rapid recovery from rocuronium-induced neuromuscular blockade. Succinylcholine is often used for brief surgeries but is associated with myalgia, headache, histamine release, and increased lactate levels. Thus, we hypothesized that succinylcholine may affect emergence agitation (EA) and compared the effects of succinylcholine and rocuronium-sugammadex on EA in patients undergoing closed reduction of a nasal bone fracture under general anesthesia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty-two patients were prospectively enrolled and allocated randomly to the succinylcholine group (group SC) or the rocuronium-sugammadex group (group RS; each<jats:italic>n<\/jats:italic>\u2009=\u200921). Neuromuscular block and its reversal were achieved with succinylcholine and normal saline in group SC, whereas rocuronium and sugammadex were administered in group RS. After surgery, the incidence of EA as a primary outcome, the incidence of dangerous EA, and duration of EA as secondary outcomes were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of EA was higher in group SC than in group RS (90.5% vs. 47.6%, respectively; relative risk [RR] 4.3; 95% confidence interval [CI] 1.2 to 15.7;<jats:italic>P<\/jats:italic>\u2009=\u2009.006). The incidence of dangerous EA increased in group SC compared to group RS (33.3% vs. 4.8%, respectively; RR 2.1; 95% CI 1.3 to 3.4;<jats:italic>P<\/jats:italic>\u2009=\u2009.045). The duration of agitation was longer in group SC than in group RS [106.5 (65.1) vs. 40.4 (26.0) sec; mean difference 66.1\u2009s; 95% CI 31.0 to 101.1; effect size 1.3;<jats:italic>P<\/jats:italic>\u2009=\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Succinylcholine increases the incidence, severity, and duration of EA compared to rocuronium-sugammadex in patients undergoing closed reduction of a nasal bone fracture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration<\/jats:title><jats:p>CRiS Registration number<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/cris.nih.go.kr\/\">KCT0002673<\/jats:ext-link>. Initial registration date was 31 January 2018 (Retrospectively registered)<jats:italic>.<\/jats:italic><\/jats:p><\/jats:sec>","DOI":"10.1186\/s12871-019-0907-3","type":"journal-article","created":{"date-parts":[[2019,12,16]],"date-time":"2019-12-16T13:02:45Z","timestamp":1576501365000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Comparison of emergence agitation between succinylcholine and rocuronium-sugammadex in adults following closed reduction of a nasal bone fracture: a prospective randomized controlled trial"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7894-8510","authenticated-orcid":false,"given":"Seok-Jin","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0714-1477","authenticated-orcid":false,"given":"Tae-Yun","family":"Sung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9906-1396","authenticated-orcid":false,"given":"Choon-Kyu","family":"Cho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2019,12,16]]},"reference":[{"key":"907_CR1","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1016\/j.joms.2014.10.013","volume":"73","author":"EA Al-Moraissi","year":"2015","unstructured":"Al-Moraissi EA, Ellis E. Local versus general anesthesia for the management of nasal bone fractures: a systematic review and meta-analysis. J Oral Maxillofac Surg. 2015;73:606\u201315.","journal-title":"J Oral Maxillofac Surg"},{"issue":"1","key":"907_CR2","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1186\/s12871-016-0279-x","volume":"16","author":"YS Lee","year":"2016","unstructured":"Lee YS, Baek CW, Kim DR, Kang H, Choi GJ, Park YH, et al. Comparison of hemodynamic response to tracheal intubation and postoperative pain in patients undergoing closed reduction of nasal bone fracture under general anesthesia: a randomized controlled trial comparing fentanyl and oxycodone. BMC Anesthesiol. 2016;16(1):115.","journal-title":"BMC Anesthesiol"},{"issue":"1","key":"907_CR3","doi-asserted-by":"publisher","first-page":"48","DOI":"10.4097\/kjae.2012.63.1.48","volume":"63","author":"YS Kim","year":"2012","unstructured":"Kim YS, Chae YK, Choi YS, Min JH, Ahn SW, Yoon JW, et al. 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\u201353.","journal-title":"Korean J Anesthesiol"},{"key":"907_CR4","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1097\/YCT.0b013e3182972bd2","volume":"30","author":"V Saricicek","year":"2014","unstructured":"Saricicek V, Sahin L, Bulbul F, Ucar S, Sahin M. Does rocuronium-sugammadex reduce myalgia and headache after electroconvulsive therapy in patients with major depression? J ECT. 2014;30:30\u20134.","journal-title":"J ECT"},{"key":"907_CR5","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1111\/j.1365-2044.2008.05873.x","volume":"64","author":"C Lee","year":"2009","unstructured":"Lee C. Goodbye suxamethonium! Anaesthesia. 2009;64:73\u201381.","journal-title":"Anaesthesia."},{"key":"907_CR6","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1007\/s40265-016-0604-1","volume":"76","author":"GM Keating","year":"2016","unstructured":"Keating GM. Sugammadex: a review of neuromuscular blockade reversal. Drugs. 2016;76:1041\u201352.","journal-title":"Drugs."},{"issue":"Suppl 1","key":"907_CR7","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1111\/j.1365-2044.2008.05872.x","volume":"64","author":"JE Caldwell","year":"2009","unstructured":"Caldwell JE, Miller RD. Clinical implications of sugammadex. Anaesthesia. 2009;64(Suppl 1):66\u201372.","journal-title":"Anaesthesia"},{"key":"907_CR8","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1097\/YCT.0b013e31825de0de","volume":"29","author":"A Postaci","year":"2013","unstructured":"Postaci A, Tiryaki C, Sacan O, Ornek D, Kalyoncu M, Dikmen B. Rocuronium-sugammadex decreases the severity of post-electroconvulsive therapy agitation. J ECT. 2013;29:e2\u20133.","journal-title":"J ECT"},{"key":"907_CR9","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1016\/S0735-6757(99)90168-7","volume":"17","author":"SL Orebaugh","year":"1999","unstructured":"Orebaugh SL. Succinylcholine: adverse effects and alternatives in emergency medicine. Am J Emerg Med. 1999;17:715\u201321.","journal-title":"Am J Emerg Med"},{"key":"907_CR10","doi-asserted-by":"publisher","first-page":"41","DOI":"10.4037\/ccn2009612","volume":"29","author":"KG Mellott","year":"2009","unstructured":"Mellott KG, Grap MJ, Munro CL, Sessler CN, Wetzel PA. Patient-ventilator dyssynchrony: clinical significance and implications for practice. Crit Care Nurse. 2009;29:41\u201355.","journal-title":"Crit Care Nurse"},{"key":"907_CR11","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1097\/00003246-199907000-00022","volume":"27","author":"RR Riker","year":"1999","unstructured":"Riker RR, Picard JT, Fraser GL. Prospective evaluation of the sedation-agitation scale for adult critically ill patients. Crit Care Med. 1999;27:1325\u20139.","journal-title":"Crit Care Med"},{"issue":"10","key":"907_CR12","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1007\/s00101-015-0077-8","volume":"64","author":"R Polat","year":"2015","unstructured":"Polat R, Peker K, Baran I, Bumin AG, G\u00fcl\u00f6ks\u00fcz TC, D\u00f6nmez A. Comparison between dexmedetomidine and remifentanil infusion in emergence agitation during recovery after nasal surgery: a randomized double-blind trial. Anaesthesist. 2015;64(10):740\u20136.","journal-title":"Anaesthesist"},{"key":"907_CR13","doi-asserted-by":"publisher","first-page":"e8843","DOI":"10.1097\/MD.0000000000008843","volume":"96","author":"YS Jee","year":"2017","unstructured":"Jee YS, You HJ, Sung TY, Cho CK. Effects of nefopam on emergence agitation after general anesthesia for nasal surgery: a prospective, randomized, and controlled trial. Medicine. 2017;96:e8843.","journal-title":"Medicine"},{"issue":"10","key":"907_CR14","doi-asserted-by":"publisher","first-page":"e14763","DOI":"10.1097\/MD.0000000000014763","volume":"98","author":"SJ Lee","year":"2019","unstructured":"Lee SJ, Choi SJ, In CB, Sung TY. Effects of tramadol on emergence agitation after general anesthesia for nasal surgery: a retrospective cohort study. Medicine. 2019;98(10):e14763.","journal-title":"Medicine"},{"key":"907_CR15","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1007\/s12630-010-9338-9","volume":"57","author":"D Yu","year":"2010","unstructured":"Yu D, Chai W, Sun X, Yao L. Emergence agitation in adults: risk factors in 2,000 patients. Can J Anesth. 2010;57:843\u20138.","journal-title":"Can J Anesth"},{"key":"907_CR16","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1093\/bja\/aep376","volume":"104","author":"S Dahmani","year":"2010","unstructured":"Dahmani S, Stany I, Brasher C, Lejeune C, Bruneau B, Wood C, et al. Pharmacological prevention of sevoflurane and desflurane-related emergence agitation in children: a meta-analysis of published studies. Br J Anaesth. 2010;104:216\u201323.","journal-title":"Br J Anaesth"},{"key":"907_CR17","doi-asserted-by":"publisher","first-page":"46","DOI":"10.3342\/ceo.2015.8.1.46","volume":"8","author":"HJ Kim","year":"2015","unstructured":"Kim HJ, Kim DK, Kim HY, Kim JK, Choi SW. Risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery. Clin Exp Otorhinolaryngol. 2015;8:46\u201351.","journal-title":"Clin Exp Otorhinolaryngol"},{"key":"907_CR18","doi-asserted-by":"publisher","first-page":"1062","DOI":"10.1097\/ALN.0b013e31826be417","volume":"117","author":"Z Jacob","year":"2012","unstructured":"Jacob Z, Li H, Makaryus R, Zhang S, Reinsel R. Metabolomic profiling of children\u2019s brains undergoing general anesthesia with sevoflurane and propofol. Anesthesiology. 2012;117:1062\u201371.","journal-title":"Anesthesiology"},{"issue":"4","key":"907_CR19","doi-asserted-by":"publisher","first-page":"410","DOI":"10.17085\/apm.2016.11.4.410","volume":"11","author":"JC Rim","year":"2016","unstructured":"Rim JC, Kim JA, Hong JI, Park SY, Lee JH, Chung CJ. Risk factors of emergence agitation after general anesthesia in adult patients. Anesth Pain Med. 2016;11(4):410\u20136.","journal-title":"Anesth Pain Med"},{"issue":"5","key":"907_CR20","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1007\/s12630-014-0128-7","volume":"61","author":"D Sabo","year":"2014","unstructured":"Sabo D, Jahr J, Pavlin J, Philip B, Shimode N, Rowe E, et al. The increases in potassium concentrations are greater with succinylcholine than with rocuronium-sugammadex in outpatient surgery: a randomized, multicentre trial. Can J Anaesth. 2014;61(5):423\u201332.","journal-title":"Can J Anaesth"},{"key":"907_CR21","first-page":"379","volume":"81","author":"J McLott","year":"2013","unstructured":"McLott J, Jurecic J, Hemphill L, Dunn KS. Development of an amygdalocentric neurocircuitry-reactive aggression theoretical model of emergence delirium in posttraumatic stress disorder: an integrative literature review. AANA J. 2013;81:379\u201384.","journal-title":"AANA J"},{"key":"907_CR22","doi-asserted-by":"publisher","first-page":"765","DOI":"10.1213\/01.ane.0000167269.62966.af","volume":"101","author":"AA Dahaba","year":"2005","unstructured":"Dahaba AA. Different conditions that could result in the bispectral index indicating an incorrect hypnotic state. Anesth Analg. 2005;101:765\u201373.","journal-title":"Anesth Analg"},{"key":"907_CR23","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1213\/ANE.0000000000001145","volume":"122","author":"HJ Frederick","year":"2016","unstructured":"Frederick HJ, Wofford K, de Lisle DG, Schulman SRA. Randomized controlled trial to determine the effect of depth of anesthesia on emergence agitation in children. Anesth Analg. 2016;122:1141\u20136.","journal-title":"Anesth Analg"},{"issue":"6","key":"907_CR24","doi-asserted-by":"publisher","first-page":"1298","DOI":"10.1097\/00000542-199712000-00006","volume":"87","author":"J Aono","year":"1997","unstructured":"Aono J, Ueda W, Mamiya K, Takimoto E, Manabe M. Greater incidence of delirium during recovery from sevoflurane anesthesia in preschool boys. Anesthesiology. 1997;87(6):1298\u2013300.","journal-title":"Anesthesiology."},{"key":"907_CR25","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1093\/bja\/aeq270","volume":"105","author":"D Chambers","year":"2010","unstructured":"Chambers D, Paulden M, Paton F, Heirs M, Duffy S, Hunter JM, et al. Sugammadex for reversal of neuromuscular block after rapid sequence intubation: a systematic review and economic assessment. Br J Anaesth. 2010;105:568\u201375.","journal-title":"Br J Anaesth"},{"key":"907_CR26","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1097\/00000542-200604000-00017","volume":"104","author":"M Jonsson","year":"2006","unstructured":"Jonsson M, Dabrowski M, Gurley DA, Larsson O, Johnson EC. Activation and inhibition of human muscular and neuronal nicotinic acetylcholine receptors by succinylcholine. Anesthesiology. 2006;104:724\u201333.","journal-title":"Anesthesiology."},{"key":"907_CR27","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1097\/EJA.0000000000000308","volume":"32","author":"S Dell-Kuster","year":"2015","unstructured":"Dell-Kuster S, Levano S, Burkhart CS, Lelais F, Zemp A, Schobinger E, et al. Predictors of the variability in neuromuscular block duration following succinylcholine: a prospective, observational study. Eur J Anaesthesiol. 2015;32:687\u201396.","journal-title":"Eur J Anaesthesiol"},{"key":"907_CR28","doi-asserted-by":"publisher","first-page":"2","DOI":"10.7243\/2049-9752-4-2","volume":"4","author":"O Viswanath","year":"2015","unstructured":"Viswanath O, Kerner B, Jean YK, Soto R, Rosen G. Emergence delirium: a narrative review. J Anesthesiol Clin Sci. 2015;4:2.","journal-title":"J Anesthesiol Clin Sci"}],"container-title":["BMC Anesthesiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-019-0907-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12871-019-0907-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12871-019-0907-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T12:39:24Z","timestamp":1613133564000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcanesthesiol.biomedcentral.com\/articles\/10.1186\/s12871-019-0907-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["907"],"URL":"https:\/\/doi.org\/10.1186\/s12871-019-0907-3","relation":{},"ISSN":["1471-2253"],"issn-type":[{"value":"1471-2253","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]},"assertion":[{"value":"27 August 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 December 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 December 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was approved by the Institutional Review Board of Konyang University Hospital, Daejeon, Korea (October 2017; KYUH 2017\u201307\u2013020-001) and written informed consent was obtained from all participants.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"228"}}