Original article

Emergence agitation in adults undergoing abdominal surgery under general anaesthesia: predictors from a two-centre prospective observational study

Authors

• • Mirza Kovacevic kovacevic.mirza@hotmail.com Email Mirza Kovacevic. (compose email, opens in email app.) Mirza Kovacevic ORCID profile. (opens in new tab)
  • Department of Anaesthesiology, Resuscitation and Intensive Care, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
• • Amir Hakanovic
  • Kardiologie Mittelland, Aarau, Switzerland
• • Alma Jahic
  • General Hospital "Prim. dr. Abdulah Nakaš'', Sarajevo, Bosnia and Herzegovina
• • Ismeta Karic Heric
  • Cantonal Hospital "Dr. Safet Mujić", Mostar, Bosnia and Herzegovina
• • Selma Sijercic
  • Clinic of Anaesthesiology, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
• • Ferid Krupic
  • Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden

Abstract

Aim: To identify factors associated with emergence agitation (EA) in adults undergoing abdominal surgery under general anaesthesia.

Methods: This prospective two-centered study included 107 patients (≥18 years) who underwent abdominal surgery at two hospital centres between February 2025 and September 2025. Collected variables included demographics, American Society of Anesthesiologists (ASA) classification, education level, smoking and alcohol use, comorbidities, fasting status, urgency and type of surgery, and anaesthesia duration. Hemodynamic parameters were recorded before induction, before endotracheal intubation (ETI), and before extubation. EA was assessed using the Richmond Agitation-Sedation Scale (RASS) and the Sedation-Agitation Scale (SAS) before (T1) and 10 minutes after extubation (T2).

Results: At T2, EA incidence was 22% (23 patients) according to SAS and 41% (44 patients) according to RASS. SAS-defined EA at T1 was associated with ASA status ≥ III (aOR 2.35, 95% CI 1.05–5.25; p = 0.028) and lower blood pressure before extubation (aOR 0.62, 95% CI 0.50–0.96; p = 0.016). SAS-defined EA at T2 was associated with higher body weight (aOR 1.20, 95% CI 1.03–1.40; p = 0.017) and higher heart rate before extubation (aOR 1.45, 95% CI 1.25–1.80; p = 0.022). According to RASS, lower blood pressure before induction was associated with EA at T1 (aOR 0.88, 95% CI 0.78–0.99; p = 0.045), while nasogastric tube presence was associated with EA at T2 (aOR 2.10, 95% CI 1.06–4.15; p = 0.034).

Conclusion: EA after general anaesthesia in adults undergoing abdominal surgery is common. Identification of associated factors may improve perioperative risk assessment and early recognition.

Keywords: hospital, incidence, patients, risk assessment

How to Cite: Kovacevic, M. , Hakanovic, A. , Jahic, A. , Karic Heric, I. , Sijercic, S. & Krupic, F. (2026) “Emergence agitation in adults undergoing abdominal surgery under general anaesthesia: predictors from a two-centre prospective observational study”, Medicinski glasnik. 23(2). doi: https://doi.org/10.17392/medglas-2194-23-2