ArticleJournal of anesthesia, analgesia and critical care2026
Sevoflurane multiple Wash In/Wash Out at the end of anesthesia to reduce agitation: a multicenter double-blind randomized controlled trial (OPERA).
Article in Journal of anesthesia, analgesia and critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04765488 (WashIn /WashOut Procedure To Prevent Agitation During Recovery After Inhalational Anesthesia With Sevoflurane), which is not on this map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
WashIn /WashOut Procedure To Prevent Agitation During Recovery After Inhalational Anesthesia With Sevoflurane: A Multicentral Randomized Trial
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
22 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPostoperative neurocognitive disorders are common and associated with adverse clinical outcomes. Existing preventive interventions are limited; the Wash In/Wash Out technique (or "wave-like awakening") might reduce the risk of postoperative neurocognitive complications. Therefore, this trial evaluated the effect of the Wash In/Wash Out technique on emergence agitation after sevoflurane-based anesthesia.
methodsIn this multicenter, double-blind, randomized trial, adult patients undergoing elective open abdominal surgery under general anesthesia with sevoflurane were randomly assigned to either an intervention group (wave-like awakening group) or a control group (standard emergence from general anesthesia). In the intervention group, sevoflurane was intermittently discontinued and immediately resumed in three consecutive cycles before awakening. The primary outcome was the incidence of emergence agitation (EA), defined as a Richmond Agitation-Sedation Scale score ≥ +2 during emergence.
resultsBetween March 2021 and February 2025, 202 patients were enrolled across three centers. The frequency of the primary endpoint was markedly low at just 1.5%, well below the anticipated rate. We found no difference in the rate of emergence agitation which occurred in 2/101 (2%) of patients in the intervention group and 1/101 (1%) in the control group (relative risk (RR), 2.00; 95% confidence interval (CI), 0.18-21.71; p > 0.999), delirium (5.9% vs. 8.9%; RR, 0.67; 95% CI, 0.25-1.82; p = 0.421), or delayed neurocognitive recovery (7.9% vs. 10.9%; RR, 0.72; 95% CI, 0.30-1.72; p = 0.470). A composite of the three postoperative neurologic complications was 13/101 (13%) vs. 19/101 (19%) (p = 0.25). We found that the median duration of delirium was shorter in the intervention group (1 [1; 1] days) than in the control group (2 [2; 3] days). No adverse event was noted.
conclusionsIn this multicenter randomized controlled trial, the Wash In/Wash Out strategy was feasible and safe but we cannot exclude clinically relevant benefit or harm on the incidence of emergence agitation due to the low event rates. We found a reduction in delirium duration in adult patients undergoing elective abdominal surgery under sevoflurane anesthesia which should be considered hypothesis generating.
trial registrationClinicalTrials.gov NCT04765488. Registered 15 February 2021.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.