Efficacy of transcranial direct current stimulation on emergence agitation in patients undergoing transurethral resection of the prostate: A double-blind, randomized, sham-controlled study #MMPMID41163224
Yang Z; Ning L; Tan H; Tong C; Wang Y; Wei K; Lin Y; Gao L; Sheng H; Yang X; Wang Y; Xu D
Chin Med J (Engl) 2025[Oct]; ? (?): ? PMID41163224show ga
BACKGROUND: Emergence agitation (EA), a significant postoperative complication, occurs due to incomplete recovery of consciousness and cognition during emergence from general anesthesia. Transcranial direct current stimulation (tDCS) improves cognitive function and awareness. This study aimed to investigate the effect of anodal tDCS applied to the left dorsolateral prefrontal cortex (DLPFC) on reducing EA in patients who underwent transurethral resection of the prostate (TURP). METHODS: In this prospective, a randomized, double-blind, and controlled clinical trial, 154 patients enrolled from October 17, 2023 to May 31, 2024 in Huashan Hospital, Fudan University were randomly assigned to receive active tDCS or sham tDCS over the left DLPFC for 10 min at the end of surgery. The primary outcome was the incidence of EA assessed using the Riker Sedation-Agitation Scale. Secondary outcomes included the incidence of dangerous EA, agitation duration, emergence time, recovery profiles, and adverse events within 24 h postoperatively. RESULTS: A total of 184 patients were enrolled, 154 were randomized, and all of them were included in the intention-to-treat analysis. The incidence of EA was significantly lower in the active-tDCS group than in the sham-tDCS group (6.5% [5/77] vs . 22.1% [17/77]; relative risk [RR] 0.29, 95% confidence interval [CI], 0.12-0.72; P = 0.010). No dangerous EA was observed in the active-tDCS group (0) compared with six cases (7.8%) in the sham group (RR, 0.08, 95% CI, 0 to 1.34; P = 0.028). Active-tDCS significantly reduced agitation duration (6.2 +/- 1.6 min vs . 11.8 +/- 3.2 min; mean difference -5.6 min, 95% CI, -8.7 to -2.5 min; P = 0.001) and accelerated the extubation time (Q1-Q3) (11.0 [10.0-12.0] min vs . 14.0 [13.6-15.8] min; hazard ratio [HR] 3.77, 95% CI, 2.66-5.34; P <0.001). CONCLUSION: One session of anodal tDCS over the left DLPFC significantly reduced the incidence of EA in patients who underwent TURP under general anesthesia.Trial Registration: Chinese Clinical Trial Registry ( http://chictr.org.cn ), ChiCTR2300076689.
Chin+Med+J+(Engl) 2025 ; ? (?): ?
