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Adult Emergence Agitation: A Veteran-Focused Narrative Review
Brian Tolly1,2, Amr Waly1, Garrett Peterson1
1From the Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.
Anesthesia and Analgesia
|November 12, 2020
Summary
Emergence agitation (EA), a state of psychomotor excitement during anesthesia recovery, lacks clear incidence and risk factors in adults. Understanding EA is crucial for patient safety and developing targeted interventions.
Area of Science:
- Anesthesiology
- Neuroscience
- Critical Care Medicine
Background:
- Emergence agitation (EA) is a transient postoperative state of psychomotor excitement.
- It is distinct from delirium, occurring during the restoration of consciousness after general anesthesia.
- EA can lead to patient and caregiver harm, with limited understanding of long-term consequences.
Purpose of the Study:
- To review and synthesize current knowledge on emergence agitation in adults.
- To clarify diagnostic criteria, risk factors, and management strategies for EA.
- To specifically address EA in the context of veteran perioperative health.
Main Methods:
- Narrative review of existing literature on emergence agitation.
- Analysis of studies on incidence, risk factors, and proposed mechanisms.
- Examination of current and potential prophylactic and therapeutic interventions.
Main Results:
- The incidence of EA in adult noncardiac surgery is approximately 19%.
- Young adults undergoing otolaryngology procedures with volatile anesthetics may be at higher risk.
- Mechanisms are theoretical, possibly involving sympathetic under-blunting; dexmedetomidine and ketamine are potential preventatives.
Conclusions:
- Distinguishing EA from delirium is essential for appropriate management.
- Further research is needed to establish true incidence, risk factors, and validate interventions, particularly in vulnerable populations like military veterans.
- Anesthesiology teams are key to developing optimized EA protocols.
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