Postanesthesia emergence in patients with post-traumatic stress disorder

Umholtz, Matthew; Cilnyk, John; Wang, Christopher K.; Porhomayon, Jahan; Pourafkari, Leili

doi:10.1016/j.jclinane.2016.02.047

Cited by 20 publications

(18 citation statements)

References 17 publications

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“…To potentially explain our observed association with PTSD and antipsychotics, PTSD has been associated with anesthesia emergence delirium [80][81][82] and ICU delirium. 83,84 However, to date, PTSD has not been identified as a risk factor for terminal delirium, 85,86 which is treated first-line with antipsychotics.…”

Section: Discussionmentioning

confidence: 99%

The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis

et al. 2019

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BACKGROUND: Post-traumatic stress disorder (PTSD) can be exacerbated by subsequent trauma, but it is unclear if symptoms are worsened by impending death. PTSD symptoms, including hyperarousal, negative mood and thoughts, and traumatic re-experiencing, can impact end-of-life symptoms, including pain, mood, and poor sleep. Thus, increased symptoms may lead to increased end-of-life healthcare utilization. OBJECTIVES: To determine if veterans with PTSD have increased end-of-life healthcare utilization or medication use and to examine predictors of medication administration. DESIGN: Secondary analysis of a stepped-wedge design implementation trial to improve end-of-life care for Veterans Affairs (VA) inpatients. Outcome variables were collected via direct chart review. Analyses included hierarchical, generalized estimating equation models, clustered by medical center. SUBJECTS: Veterans, inpatient at one of six VA facilities, dying between 2005 and 2011. MAIN MEASURES: Emergency room (ER) visits, hospitalizations, and medication administration in the last 7 days of life. KEY RESULTS: Of 5341 veterans, 468 (8.76%) had PTSD. Of those, 21.4% (100/468) had major depression and 36.5% (171/468) had anxiety. Veterans with PTSD were younger (mean age 65.4 PTSD, 70.5 no PTSD, p < 0.0001) and had more VA hospitalizations and ER visits in the last 12 months of life (admissions: PTSD 2.8, no PTSD 2.4, p < 0.0001; ER visits: 3.2 vs 2.5, p < 0.0001). PTSD was associated with antipsychotic administration (OR 1.52, 95% CI 1.06-2.18). Major depression (333/5341, 6.2%) was associated with opioid administration (OR 1.348, 95% CI 1.129-1.609) and benzodiazepines (OR 1.489, 95% CI 1.141-1.943). Anxiety disorders (778/5341, 14.6%) were only associated with benzodiazepines (OR 1.598,. CONCLUSIONS: PTSD's association with increased endof-life healthcare utilization and increased antipsychotic administration in the final days of life suggests increased symptom burden and potential for terminal delirium in individuals with PTSD. Understanding the burden of psychiatric illness and potential risks for delirium may facilitate the end-of-life care for these patients.

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Section: Discussionmentioning

confidence: 99%

The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis

et al. 2019

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“…In a clinical trial of 317 veterans with post-traumatic stress disorder (PTSD), Umholtz M et al found that 15 (4.7%) of the 317 veterans had delirium after anesthesia, and their postoperative recovery was lower than expected, indicating that PTSD independently predicted the occurrence of delirium. In addition, the study also found that the post anesthesia care unit (PACU) stay time of PTSD patients was relatively long, which may relect the increased awareness of medical staf of this debilitating mental disorder (Umholtz, et al, 2016). The preoperative mental health declines, and the postoperative quality of life will also deteriorate, so preoperative mental health screening is very important (Watanabe, et al, 2020).…”

Section: Preoperative Cognitive Impairmentmentioning

confidence: 99%

Research status and prospect of peri‐extubation delirium

Jiang

Zhu

et al. 2021

Ibrain

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Peri‐extubation delirium is a clinical syndrome caused by multiple factors, and it is not a simple disease. It occurs within a period of time after extubation when the effect of general anesthesia is reduced. And the incidence is different in disparate populations, and it is more common in elderly patients. Current studies have shown that iatrogenic factors and patients' own factors are the main risk factors for the syndrome. Early identification of risk factors can help clinicians make early diagnosis. The earlier the diagnosis and treatment begin, the more significantly the prognosis of patients can be improved. At present, the treatment of perioperative delirium is based on non‐drug therapy, supplemented by drug therapy. This review will introduce in detail the risk factors, population status and prevention measures of delirium during peri‐extubation, and look forward to the new research direction in the future.

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“…For those patients with PTSD requiring general anesthesia, there is an increased risk of emergence delirium [57]. Careful care should be taken prior to waking the patient, restraints are an option along with proper awareness among the staff to be prepared.…”

Section: Post-traumatic Stress Disordermentioning

confidence: 99%