Inadequate emergence after anesthesia: emergence delirium and hypoactive emergence in the Postanesthesia Care Unit

• Type: Article in International Scientific Journal
• Date: 2013

Authors

Xara, D (Author) Other; Silva, A (Author) Other; Mendonca, J (Author) Other; Abelha, F (Author) FMUP

Journal

Title: Journal of Clinical Anesthesia

Vol. 25

Pages: 439-446

ISSN: 0952-8180

Publisher: Elsevier

Indexing

ISI Web of Knowledge - 51 Citations

Scopus - 59 Citations

Other information

Authenticus ID: P-008-G3Q

DOI: 10.1016/j.jclinane.2013.02.011

Abstract (EN): Study Objective: To evaluate the frequency, determinants, and outcome of inadequate emergence after elective surgery in the Postanesthesia Care Unit (PACU). Design: Prospective observational study. Setting: 12-bed PACU of a tertiary-care hospital in a major metropolitan area. Patients: 266 adult patients admitted to the PACU. Intervention: To evaluate inadequate emergence, the Richmond Agitation and Sedation Scale (RASS) was administered to patients 10 minutes after their admission to the PACU. Measurements: Demographic data, perioperative variables, and postoperative length of stay (LOS) in the PACU and the hospital were recorded. Main Results: 40 (15%) patients showed symptoms of inadequate emergence: 17 patients (6.4%) screened positive for emergence delirium and 23 patients (8.6%) showed hypoactive emergence. Determinants of emergence delirium were longer duration of preoperative fasting (P = 0.001), higher visual analog scale (VAS) scores for pain (P = 0.002), and major surgical risk (P = 0.001); these patients had a higher frequency of postoperative delirium (P = 0.017) and had higher nausea VAS score 6 hours after surgery (P = 0.001). Determinants of hypoactive emergence were duration of surgery (P = 0.003), amount of crystalloids administered during surgery (P = 0.002), residual neuromuscular block (P < 0.001), high-risk surgery (P = 0.002), and lower core temperature on PACU admission (P = 0.028); these patients also had more frequent residual neuromuscular block (P < 0.001) postoperative delirium (P < 0.001), and more frequent adverse respiratory events (P = 0.02). Patients with hypoactive emergence had longer PACU and hospital LOS. Conclusions: Preventable determinants for emergence delirium were higher postoperative pain scores and longer fasting times. Hypoactive emergence was associated with longer postoperative PACU and hospital LOSs.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 8