Causes of anesthesia: 1, preoperative medication:The application of anticholinergic drugs is positively correlated with post-anesthesia excitement, haloperidol, high doses of benzodiazepines such as gastrofacial, imipramine, and opioids, such as dulcolax. 2, induction and maintenance drugs, including imipramine, etomidate, sodium thiopental, and chlorambucil, have been proposed in relevant abstracts to cause agitation during the awakening period. As for volatile inhalation anesthetic drugs, a large number of scholars have done experimental studies in this regard, and most of them are now considered to be a relatively important cause of agitation, such as halothane, ether, and the new generation of inhalation anesthetics sevoflurane, desflurane, isoflurane, etc. In children, there have been some trials without surgical procedures showing that inhaled anesthetics can still cause agitation when the surgical factor is removed and there is no pain stimulation. The mechanism of agitation caused by inhaled anesthetics is still unknown, and this is one of the issues we need to further explore and study. 3, rapid awakening, Cravero etal believes that the EA caused by rapid awakening prolongs the time the patient stays in the anesthesia recovery room, so the pros and cons are not particularly advantageous. The concentration of inhaled anesthetic drugs decreases sharply in the short term, the timing of extubation is inappropriate, the patient is aware, the patient has recovered sensation but not yet consciousness, and is hypersensitive to external stimuli. However, a considerable number of scholars believe that rapid awakening and EA are not very relevant, 4, the residual effect of muscarinic drugs, muscarinic drug residues can lead to severe anxiety and agitation, when possible, muscarinic monitoring, or routine antagonistic muscarinic. Certain physiological, pathological and pharmacological factors may affect the sensitivity of brain tissues to anesthetic drugs, and conventional medication cannot meet the requirements of all patients. However, in some tests where pain is excluded, agitation still exists, and pain cannot explain all agitation. 6, biochemical and respiratory and circulatory instability: airway obstruction, hypoxemia, hypovolemia, acidosis, hypercapnia, hyponatremia, hypoglycemia, sepsis, etc., all of which can cause agitation or delirium. 7, other causes: hypothermia, bladder distension, irritation of the urinary catheter, these causes need to be carefully observed in our clinical work to exclude. Surgical causes: 1, may be related to the surgical site, in the ear, nose and throat surgery, respiratory tract, breast and reproductive system and other parts of the surgical operation with a closer relationship with emotion, in children with a history of previous surgery on the ear, tonsil, nose, neck, larynx and other parts of the waking period agitation and emotional instability hair occur higher. 2, the extracorporeal circulation and other surgical operations caused by the micro-air embolism of the cerebral vessels, can cause postoperative psychomotor and neurological dysfunction, the longer the time of such operations, the higher the chance of delirium after surgery. The patient’s own factors: 1. The age of the patient, epidemiological studies have shown that the incidence of EA is more common in preschool children and the elderly. Whether the higher incidence in elderly patients is related to the abnormal secretion of melatonin, a considerable number of scholars have done some research in this regard. 2. Preoperative anxiety, excessive preoperative stress, and excessive concern about the risks of surgery and anesthesia can increase the occurrence of EA. There are more studies in this area in children, and the Yale Anxiety Scale (mYPAS) is used to assess the preoperative anxiety state, and studies have shown that there is a positive correlation between preoperative anxiety and postoperative EA, while in adults, there is a lack of studies in this area due to the lack of assessment criteria for preoperative anxiety state. 3, Innate arousal to anesthetic drugs, including inhaled anesthetic drugs, some intraoperative hypnotic sedative drugs and opioid use, which may be related to the patient’s genetics, needs to be further explored here. 4, previous alcohol addiction, opioid addiction, anesthesia awakening period will appear similar to the withdrawal syndrome performance. Patients with long-term use of antidepressant drugs, long-term use will reduce the reuptake of norepinephrine and 5-hydroxytryptamine, blocking acetylcholine receptors and histamine receptors (H1, and H2 receptors), in the inhalation of general anesthesia is easy to cause convulsions or arrhythmias, EA birth rate is higher than the average patient. Prevention and treatment of EA For the occurrence of EA we can still prevent the treatment according to the above related high-risk factors, for susceptible people to use drugs carefully, try to avoid the occurrence, and have adequate preparation so that they can be dealt with in a timely and appropriate manner. There are also a large number of scholars have done relevant clinical research, the following probably put forward some ideas for reference. In addition to assessing the patient’s anesthesia risk and tolerance, we should communicate with the patient and try to eliminate the patient’s confusion and fear of anesthesia and surgery. For pediatric patients, we should communicate with their parents and ask them to explain patiently to their children. 2. Give reasonable preoperative medical advice according to each patient’s condition during the preoperative visit. Use benzodiazepine sedative-hypnotic drugs and anticholinergic drugs (reduce the use of scopolamine and generally use atropine instead) with caution in patients who are nervous and difficult to cooperate, elderly patients and pediatric patients. In addition, preoperative use of imipramine has been reported to reduce EA, arguing that imipramine counteracts the rapid resuscitation due to sevoflurane and that the total time of patient resuscitation is not prolonged. Do individualize the medication to avoid EA due to improper preoperative medication. 3. Induction and intraoperative maintenance medication. If the patient is at high risk of EA, then the intravenous drugs used for induction should be avoided as much as possible, such as etomidate and thiopental sodium. Inhalation anesthetic drugs are widely used in pediatric induction in foreign countries in addition to general anesthesia maintenance use, while in China, although induction use is less, but because of the rapid development of inhalation anesthetic drugs, the advantages are clear, so the use is also very widespread. Therefore, we should consider how we can reduce the EA caused by the use of inhaled full-blown drugs, and SKubo et al. suggested that the intraoperative combination of isoproterenol might be an effective method. In addition, the use of fentanyl may reduce the occurrence of EA, and in children 2 or 5 μg/kg of fentanyl administered intravenously in combination with static inhalation of general anesthesia may reduce EA. In pediatric patients, fentanyl l 2microg/kg nasal drip can also reduce EA. colistin used after induction of anesthesia, can be used intravenously, also can be used epidurally, there are more literature pointed out that can reduce EA. ketorolac (ketorolac is a non-steroidal anti-inflammatory analgesic) given during the awakening period of anesthesia can easily reduce the occurrence of EA. 4. Good postoperative analgesia. It is undeniable that surgery is a big trauma for the patient, so to minimize the pain caused by this trauma, we need to use postoperative analgesia reasonably and appropriately, whether intravenous or epidural or other modes of administration, all need to be “titrated” according to the patient’s condition ( Whether intravenous or extravascular or other modes of administration, we need to “titrate” (cautioustitration) the medication according to the patient’s condition, observe the patient’s response to the medication, and prevent delayed awakening and toxic side effects while providing good pain relief. Achieving a good pain relief effect within the safe dose range has always been pursued by many clinicians in their work. 5.Keep the airway open, maintain the stability and balance of circulation, respiration, water-electrolyte and other systems. In some cases where the operation time is long, the patient’s condition is poor, or the operation is traumatic, attention should be paid to monitoring the circulatory system, blood gas and water-electrolyte during the perioperative period to prevent agitation and delirium due to hypoxemia, hypercarbia and other water-electrolyte disorders. 6. Treatment after the appearance of EA. First of all, we should exclude cardiovascular accidents, epilepsy and other organic brain lesions, and exclude the causes of the above two categories 4 and 5, and then deal with the situation according to the agitation. In adult as well as elderly patients there is a lack of rating for this and therefore there is a lack of uniform guidelines for the conditions in which pharmacological intervention is needed. In pediatric patients, a five-point agitation score can be used to assess ① Ensure oxygen supply and airway patency, and closely monitor the respiratory circulation system; ② The use of sedative drugs: in adults, the following drugs are commonly used: Valium 2, 5 to 5 mg IV, or Lorazepam 1 to 2 mg IV, which can be increased if agitation persists, and Haloperidol (0, 5 to 5 mg IV in adults, every 20 to 30 minutes). 30 minutes), which is more controversial because some patients can develop extrapyramidal symptoms after its use. In clinical work more commonly used also Propofol, a single 5mg or 10mg IV, if the effect is not satisfactory can increase the amount of drug. ③ opioid use: including morphine, fentanyl, dulcolax, etc., these drugs are also more commonly used in clinical work, the use of caution according to the patient’s condition, the use of titration of drugs to prevent the occurrence of central respiratory depression. ④ Other medications: such as cortisone, tramadol, etc., can also reduce EA.