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Inadequate emergence after anesthesia: emergence delirium and hypoactive emergence in the Postanesthesia Care Unit
Daniela Xará1, Acácio Silva, Júlia Mendonça
1Department of Anesthesiology, Postanesthesia Care Unit, Centro Hospitalar de São João, Porto 4200-465, Portugal.
Insights
Inadequate emergence after surgery, including delirium and hypoactive states, affects 15% of patients. Preventable factors like pain and fasting times influence emergence delirium, while hypoactive emergence prolongs recovery.
Area of Science:
- Anesthesiology
- Critical Care Medicine
- Surgical Outcomes
Background:
- Inadequate emergence from anesthesia in the Postanesthesia Care Unit (PACU) can complicate patient recovery.
- Understanding the frequency and predictors of inadequate emergence is crucial for optimizing patient care.
Purpose of the Study:
- To determine the incidence of inadequate emergence.
- To identify factors influencing emergence delirium and hypoactive emergence.
- To assess the outcomes associated with inadequate emergence.
Main Methods:
- A prospective observational study was conducted in a 12-bed tertiary-care hospital PACU.
- 266 adult patients were assessed using the Richmond Agitation and Sedation Scale (RASS) 10 minutes post-admission.
- Data collected included demographics, perioperative variables, and postoperative length of stay (LOS).
Main Results:
- 15% of patients (n=40) experienced inadequate emergence, comprising emergence delirium (6.4%) and hypoactive emergence (8.6%).
- Emergence delirium was linked to prolonged fasting, higher pain scores, and major surgical risk, correlating with increased postoperative delirium and nausea.
- Hypoactive emergence was associated with longer surgery, greater crystalloid administration, residual neuromuscular block, high-risk surgery, and lower core temperature, leading to more frequent delirium, respiratory events, and extended LOS.
Conclusions:
- Emergence delirium is linked to modifiable factors such as preoperative fasting duration and postoperative pain management.
- Hypoactive emergence is associated with increased PACU and hospital length of stay.
- Targeting these determinants can potentially improve patient outcomes and reduce healthcare resource utilization.
Study Objective:
To evaluate the frequency, determinants, and outcome of inadequate emergence after elective surgery in the Postanesthesia Care Unit (PACU).
Design:
Prospective observational study.
Setting:
12-bed PACU of a tertiary-care hospital in a major metropolitan area.
Patients:
266 adult patients admitted to the PACU.
Intervention:
To evaluate inadequate emergence, the Richmond Agitation and Sedation Scale (RASS) was administered to patients 10 minutes after their admission to the PACU.
Measurements:
Demographic data, perioperative variables, and postoperative length of stay (LOS) in the PACU and the hospital were recorded.
Main Results:
40 (15%) patients showed symptoms of inadequate emergence: 17 patients (6.4%) screened positive for emergence delirium and 23 patients (8.6%) showed hypoactive emergence. Determinants of emergence delirium were longer duration of preoperative fasting (P = 0.001), higher visual analog scale (VAS) scores for pain (P = 0.002), and major surgical risk (P = 0.001); these patients had a higher frequency of postoperative delirium (P = 0.017) and had higher nausea VAS score 6 hours after surgery (P = 0.001). Determinants of hypoactive emergence were duration of surgery (P = 0.003), amount of crystalloids administered during surgery (P = 0.002), residual neuromuscular block (P < 0.001), high-risk surgery (P = 0.002), and lower core temperature on PACU admission (P = 0.028); these patients also had more frequent residual neuromuscular block (P < 0.001) postoperative delirium (P < 0.001), and more frequent adverse respiratory events (P = 0.02). Patients with hypoactive emergence had longer PACU and hospital LOS.
Conclusions:
Preventable determinants for emergence delirium were higher postoperative pain scores and longer fasting times. Hypoactive emergence was associated with longer postoperative PACU and hospital LOSs.
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