Incidence and Risk Factors of Emergence Delirium after Anesthesia in Elderly Patients at a Postanesthesia Care Unit in Ethiopia: Prospective Observational Study

Assefa, Muleta Teshome; Chekol, Wubie Birlie; Melesse, Debas Yaregal; Nigatu, Yonas Addisu

doi:10.2147/prom.s297871

Cited by 3 publications

(9 citation statements)

References 31 publications

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“…Our nding is relatively low as compared to the previous study. This variation might be explained by the inclusion of patients who underwent emergency surgery (which had high Prevalence of emergence delirium as it permits limited time to optimize patients operated in emergency setting), and might be due to the large sample size used in the previous study and tool difference (17,21).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of emergence delirium and associated factors among old-age patients who underwent elective surgery in the Teaching Hospitals of Ethiopia, Ethiopia, 2021. A multicenter prospective observational study

Tageza

2022

Preprint

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Background Emergence Delirium is a common and serious post-operative complication in surgical patients, especially in the old-age. It occurs at any time in the perioperative period, during or immediately following emergence from general anesthesia. Unfortunately, it is highly associated with post-operative complications such as decrease in functional capacity, prolonged hospital stay, an increase in health care costs and morbidity and mortality. The goal of this study was to determine the prevalence of emergence delirium and associated factors among old-age patients who underwent elective surgery in the Teaching Hospitals of Ethiopia at post anesthesia care unit, 2021. Methods A multi-center prospective observational study was conducted at the post-anesthetic care unit of four teaching hospitals in Ethiopia. Old-age surgical patients admitted to Post-anesthesia Care Unit who underwent elective surgery in the four Teaching Hospitals of Ethiopia were selected by using simple random sampling. Pretested structured questionnaire was used to collect data. Data were entered in to Epidata (version 4.6) and exported to the SPSS (version 25.0). Binary logistic regression was used to identify factors independently associated with emergence delirium. Results Out of 384 old-age patients included in the study with 100% response rate, the Prevalence of emergence delirium was 27.6%. Preoperative low hemoglobin levels (AOR: 2.0, 95%CI; 1.77–3.46), opioids (AOR: 8.0, 95%CI; 3.22–27.8) and anti-cholinergic premedications (AOR: 8.5, 95%CI; 6.85–17.35), and post-operative pain (AOR: 3.10, 95CI; 2.07–9.84) at PACU were independently associated with emergence delirium. Conclusion The Prevalence of emergence delirium was high. Old-age patients who were premedicated with anti-cholinergic and opioids, those patients who had low pre-operative hemoglobin and post-operative pain were independently associated with emergence delirium. Adequate pre-operative optimization and post-operative analgesia may reduce the Prevalence of emergence delirium.

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Section: Discussionmentioning

confidence: 99%

Prevalence of emergence delirium and associated factors among old-age patients who underwent elective surgery in the Teaching Hospitals of Ethiopia, Ethiopia, 2021. A multicenter prospective observational study

Tageza

2022

Preprint

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“…Our finding is relatively low as compared to the previous study. is variation might be explained by the inclusion of patients who underwent emergency surgery (which had a high prevalence of emergence delirium as it permits limited time to optimize patients operated in an emergency setting) and might be due to the large sample size used in the previous study and tool difference [23,27].…”

Section: Discussionmentioning

confidence: 99%

“…is finding is supported by another study that argued that opioids increase the likelihood of adverse outcomes such as delirium. is variation might be explained as there exists increased drug sensitivity in older patients due to the dramatic changes in receptor function, which heightened the sensitivity of the brain toward adverse effects of opioids leading to delirium [23,27,30,31]. Older patients who had anticholinergic premedication were 8.5 times (AOR: 8.5, 95% CI: 8.5 (6.85-17.35) more likely to develop emergence delirium as compared to those who were not given anticholinergic premedication.…”

Section: Discussionmentioning

confidence: 99%

“…is was argued by another study, which concluded that inadequate analgesia in the perioperative period had been strongly associated with the emergence delirium. e possible explanation for this might be due to the perceived psychological effects of pain, and pain may favor alterations in the neurotransmitter systems inducing the proinflammatory mediators and impairing the physiological stress response resulting in neurophysiological dysfunctions that may potentiate cognitive impairments that may be manifested as delirium [10,27,34].…”

Section: Discussionmentioning

confidence: 99%

“…Postoperative sedation (consciousness) and agitation were assessed by the Richmond Agitation Sedation Scale (RASS), a 10-point scale between +4 and −5 [24,26,27].…”

Section: Operational Definitionmentioning

confidence: 99%

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Prevalence of Emergence Delirium and Associated Factors among Older Patients Who Underwent Elective Surgery: A Multicenter Observational Study

Mekonin

Olika

Wedajo

et al. 2022

Anesthesiology Research and Practice

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Background. Emergence delirium is a common and serious postoperative complication in older surgical patients. It occurs at any time in the perioperative period, during or immediately following emergence from general anesthesia. Unfortunately, it is highly associated with postoperative complications such as a decrease in functional capacity, prolonged hospital stay, an increase in health care costs, and morbidity and mortality. The goal of this study was to determine the prevalence of emergence delirium and associated factors among older patients who underwent elective surgery in the teaching hospitals of Ethiopia at the postanesthesia care unit in 2021. Methods. A multicenter prospective observational study was conducted at the postanesthetic care unit in the four teaching hospitals of Ethiopia. Older surgical patients admitted to the postanesthesia care unit who underwent elective surgery in the four teaching hospitals of Ethiopia were selected by using simple random sampling. Pretested structured questionnaire was used to collect data. Data were entered into EpiData (version 4.6) and exported to the SPSS (version 25.0). Binary logistic regression was used to identify factors independently associated with the emergence delirium. Results. Out of 384 older patients included in the study, the prevalence of emergence delirium was 27.6%. Preoperative low hemoglobin levels (AOR: 2.0, 95% CI; 1.77–3.46), opioid (AOR: 8.0, 95% CI; 3.22–27.8), anticholinergic premedications (AOR: 8.5, 95% CI; 6.85–17.35), and postoperative pain (AOR: 3.10, 95 CI; 2.07–9.84) at PACU were independently associated with emergence delirium. Conclusion. The prevalence of emergence delirium was high among older patients who underwent elective surgery. Opioid and anticholinergic premedication, low preoperative hemoglobin, and the presence of postoperative pain were independently associated with the emergence delirium. Adequate preoperative optimization and postoperative analgesia may reduce the prevalence of emergence delirium.

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Intraoperative body temperature and emergence delirium in elderly patients after non-cardiac surgery: a secondary analysis of a prospective observational study

Wang

et al. 2023

Chinese Medical Journal

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Background: Emergence delirium (ED) is a kind of delirium that occured in the immediate post-anesthesia period. Lower body temperature on post-anesthesia care unit (PACU) admission was an independent risk factor of ED. The present study was designed to investigate the association between intraoperative body temperature and ED in elderly patients undergoing non-cardiac surgery. Methods: This study was a secondary analysis of a prospective observational study. Taking baseline body temperature as a reference, intraoperative absolute and relative temperature changes were calculated. The relative change was defined as the amplitude between intraoperative lowest/highest temperature and baseline reference. ED was assessed with the confusion assessment method for intensive care unit at 10 and 30 min after PACU admission and before PACU discharge. Results: A total of 874 patients were analyzed with a mean age of 71.8 ± 5.3 years. The incidence of ED was 38.4% (336/874). When taking 36.0°C, 35.5°C, and 35.0°C as thresholds, the incidences of absolute hypothermia were 76.7% (670/874), 38.4% (336/874), and 17.5% (153/874), respectively. In multivariable logistic regression analysis, absolute hypothermia (lowest value <35.5°C) and its cumulative duration were respectively associated with an increased risk of ED after adjusting for confounders including age, education, preoperative mild cognitive impairment, American Society of Anesthesiologists grade, duration of surgery, site of surgery, and pain intensity. Relative hypothermia (decrement >1.0°C from baseline) and its cumulative duration were also associated with an increased risk of ED, respectively. When taking the relative increment >0.5°C as a threshold, the incidence of relative hyperthermia was 21.7% (190/874) and it was associated with a decreased risk of ED after adjusting above confounders. Conclusions: In the present study, we found that intraoperative hypothermia, defined as either absolute or relative hypothermia, was associated with an increased risk of ED in elderly patients after non-cardiac surgery. Relative hyperthermia, but not absolute hyperthermia, was associated with a decreased risk of ED. Registration: Chinese Clinical Trial Registry (No. ChiCTR-OOC-17012734).

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Incidence and Risk Factors of Emergence Delirium after Anesthesia in Elderly Patients at a Postanesthesia Care Unit in Ethiopia: Prospective Observational Study

Cited by 3 publications

References 31 publications

Prevalence of emergence delirium and associated factors among old-age patients who underwent elective surgery in the Teaching Hospitals of Ethiopia, Ethiopia, 2021. A multicenter prospective observational study

Prevalence of emergence delirium and associated factors among old-age patients who underwent elective surgery in the Teaching Hospitals of Ethiopia, Ethiopia, 2021. A multicenter prospective observational study

Prevalence of Emergence Delirium and Associated Factors among Older Patients Who Underwent Elective Surgery: A Multicenter Observational Study

Intraoperative body temperature and emergence delirium in elderly patients after non-cardiac surgery: a secondary analysis of a prospective observational study

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