Agitation in adults in the post-anaesthesia care unit after general anaesthesia

Fields, Amanda R.; Huang, Jeffrey; Schroeder, Darrell R.; Šprung, Juraj; Weingarten, Toby N.

doi:10.1016/j.bja.2018.07.017

Cited by 83 publications

(92 citation statements)

References 33 publications

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“…This outcome is in concordance with the earlier observation of Kain and co-workers that, anxious children during the induction of anesthesia increased their likelihood of developing postoperative negative behavioral changes (Kain et al 1999;2004). As well as the nding that adult patient aged more than 18 years, with postoperative agitation after GA were at high risk of postoperative delirium (Fields et al 2018).…”

Section: Discussionsupporting

confidence: 91%

Postoperative cognitive recovery in children after both general and locoregional anesthesia and surgery

Hammoumi

Dahchour

Chhiti

et al. 2020

Preprint

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Background and objectivesRecent researches have demonstrated that there is a progressive impairment in neurocognitive function following general anesthesia and surgery, and particularly, have evidenced that anesthetics impaired mechanisms of learning and memory, for days to months, in both adults and children.This study aimed to evaluate the influence of different types of anesthesia (General or Locoregional) on cognitive recovery by trial and error method, and also take into consideration other factors that would have an impact on the cognitive performance after anesthesia and surgery in children.MethodsIn the present cross-sectional study, 64 young children, aged between 10 and 15 years, have passed the CALM test (software based on trial and error method) 24h after their surgery, and the operating file filled by the anesthetist. The statistical analysis includes a descriptive part of our sample, a univariate, and multivariate analysis of the results of the CALM test and the various medical factors and lifestyles.Results and conclusionsThe cognitive performance of patients exposed to locoregional anesthesia (81.3%) was higher (p=0.01) when compared to patients under general anesthesia (34.4%). Both agitation (Neurological state) and postoperative pain significantly (p=0.02) altered the cognitive performance of patients. However, none of the other factors assessed such as gender, environmental living, schooling, pre-anesthetic consultation, and the type of intervention affects the postoperative cognitive performance of patients.Locoregional anesthesia has less effect on cognitive recovery when compared to general anesthesia. Both the postoperative pain and agitation alter cognitive performances of operated children.

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Section: Discussionsupporting

confidence: 91%

Postoperative cognitive recovery in children after both general and locoregional anesthesia and surgery

Hammoumi

Dahchour

Chhiti

et al. 2020

Preprint

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“…In adults, the association between age and EA has varied among studies. Age was not associated with EA in a prospective observational study of 2000 patients, as well as in a case-controlled study [2,3]. In contrast, among studies that showed a relationship between age and EA, a variety of age groups were reported as risk factors for EA.…”

Section: Agementioning

confidence: 85%

Section: Proposed Risk Factors For Emergence Agitationmentioning

confidence: 99%

“…Emergence agitation (EA) is a phenomenon that includes restlessness, disorientation, excitation, non-purposeful movement, inconsolability, thrashing, and incoherence during early recovery from general anesthesia [1]. The incidence of EA varies widely from approximately 0.25% to 90.5%, according to age, assessment tool used, definitions, anesthetic techniques, type of surgery, and time at which EA is assessed during recovery [2][3][4][5][6]. The clinical consequences of EA are as varied as the incidence of EA.…”

Section: Introductionmentioning

confidence: 99%

“…However, both EA and ED should be differentiated from postoperative delirium; postoperative delirium is a concept that includes ED (i.e., ED represents the very early onset of postoperative delirium in the operating room or on arrival at the postanesthesia care unit [PACU] immediately after the anesthesia period) [18,21,22]. EA and ED in the PACU are reportedly strong predictors of postoperative delirium, which is associated with prolonged hospital stay and increased morbidity (e.g., pulmonary complications), mortality, and the need for institutionalization of adult patients [2,23]. As in previous studies [16,17,24,25], the terms EA and This article is protected by copyright of Korean Journal of Anesthesiology.…”

Section: Introductionmentioning

confidence: 99%

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Emergence agitation: current knowledge and unresolved questions

Lee

Sung

2020

Korean J Anesthesiol

114

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This article is protected by copyright of Korean Journal of Anesthesiology. All rights reserved. Emergence agitation (EA), which is also referred to as emergence delirium, can lead to clinically significant consequences. The mechanism of EA remains unclear. Proposed contributors to EA include age, male sex, type of surgery, emergency operation, use of inhalational anesthetics with low blood-gas partition coefficients, long duration of surgery, anticholinergics, premedication with benzodiazepines, voiding urgency, postoperative pain, and the presence of invasive devices. If preor intraoperative objective monitoring could predict the occurrence of agitation during emergence, this would help to reduce the adverse consequences of EA. Several tools are available for assessing EA; however, its incidence varies considerably according to the assessment tool and definition of EA used, due to the absence of standardized clinical research practice guidelines. Total intravenous anesthesia, propofol, μ-opioid agonists, N-methyl-D-aspartate receptor antagonists, nefopam, α2adrenoreceptor agonists, regional analgesia, multimodal analgesia, parent-present induction, and preoperative education for surgery may contribute to prevention of EA. However, it is difficult to identify patients at high risk for EA and to properly apply EA prevention methods in various clinical situations, because both risk factors and preventive strategies often show inconsistent results depending on the methodology of the study and the patients assessed. This review discusses the most important research topics related to EA and directions for future research.

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Effect of Tropisetron on Prevention of Emergence Delirium in Patients After Noncardiac Surgery

et al. 2020

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IMPORTANCE Postoperative delirium is a frequent disorder for patients undergoing surgery and is associated with poor outcomes. Delirium may occur in the immediate period after anesthesia administration and surgery. Tropisetron, which is frequently administrated for postoperative nausea and vomiting, is also a partial agonist of α7 nicotinic acetylcholine receptors associated with neuroprotective effects. Tropisetron may be the potential pharmacological treatment to decrease delirium after noncardiac surgery. OBJECTIVE To perform a randomized clinical trial to determine the efficacy and safety of tropisetron for prevention of emergence delirium in patients undergoing noncardiac surgery. DESIGN, SETTING, AND PARTICIPANTS This single-center, 2-arm randomized, double-blind, placebo-controlled trial will include 1508 patients undergoing noncardiac surgery. The intervention group will receive 5 mg of intravenous tropisetron before anesthesia induction, and patients in the control group will receive a placebo. The primary end point is the incidence of emergence delirium within 1 hour after tracheal tube removal, measured by the Confusion Assessment Method for the Intensive Care Unit score. The main secondary outcome is the incidence of postoperative delirium measured at 3 days of follow-up. An intention-to-treat principle will be used for all analyses. DISCUSSION Delirium remains the most common neuropsychiatric complication for patients after surgery. This will be the first randomized clinical study to evaluate whether tropisetron is effective in preventing emergence delirium. Results from this study will provide evidence for alteration of daily practice. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04027751

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Agitation in adults in the post-anaesthesia care unit after general anaesthesia

Cited by 83 publications

References 33 publications

Postoperative cognitive recovery in children after both general and locoregional anesthesia and surgery

Postoperative cognitive recovery in children after both general and locoregional anesthesia and surgery

Emergence agitation: current knowledge and unresolved questions

Effect of Tropisetron on Prevention of Emergence Delirium in Patients After Noncardiac Surgery

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