Role of preemptive chlorpheniramine maleate in reducing postoperative agitation after functional endoscopic sinus surgeries (FESS)

Background
Agitation with general anesthesia for ear, nose, and throat (ENT) surgeries was so frequent reaching up to 55.4%. Chlorpheniramine maleate a first-generation antihistaminic that antagonizes histamine H1-receptor. It is specifically a potent inverse agonist of the histamine H1 receptor. It is mainly used as an anti-allergic but has some anti-depressant and anti-anxiety actions, with unknown mechanism as well.
Subjects and methods
A total of 90 adult patients undergoing FESS procedure for chronic sinusitis with bilateral postoperative nasal packing. Patients were randomly assigned into two equal groups. The first group (A) 45 patients received chlorpheniramine maleate 5 mg diluted in 9 ml isotonic saline IV 30 min preinduction of general anesthesia while the second group (B) received 10 ml isotonic saline IV as control.
Statistical analysis
It was done using the Statistical Package for Social Sciences (SPSS/version 21) software using arithmetic mean, standard deviation, chi square test, Fisher exact test and test. The level of significance was 0.05.
Results
The degree of agitation measured by (RASS) and the number of patients needed midazolam and its total dose given to reduce severity of agitation postoperatively was remarkably less in group (A) than group (B).
Conclusion
Preoperative single dose of chlorpheniramine maleate is an effective medication that may be used to prevent or reduce the severity of emergence agitation with minimal cardio-respiratory depression.