Pharmacologic, physiologic, and psychological characteristics associated with emergence delirium in combat veterans

The goal of this research was to investigate, through active-duty Army anesthesia providers, their perceptions on emergence delirium (ED) in US combat veterans. Specifically, the pharmacologic, physiologic, and psychological characteristics associated with ED. An online survey was sent to all active-duty Army anesthesia providers with a response rate of 34%. Results indicated that the providers overwhelmingly agreed that ED was related to type of anesthetic used (67.1%) with potent inhalational agents and ketamine ranking highest (88.6% and 63.6%, respectively). Providers also overwhelmingly considered both physiologic and psychological factors (86.8% and 97.1%, respectively) as producing ED in combat veterans. Young age (57.5%) and traumatic brain injury (54.2%) were believed to be the most likely physiologic factors, with posttraumatic stress disorder (88%) and anxiety (84.8%) rated highest for psychological factors related to ED. This study emphasizes the need to develop a prospective clinical database involving all military anesthesia providers that could collect demographic, pharmacologic, psychological, and physiologic information on all combat veterans undergoing anesthesia. This kind of longitudinal data would provide answers to many of the unanswered questions that we currently have regarding combat veterans and ED.