Emergence delirium following sevoflurane anesthesia in adults: prospective observational study

Ramroop, Renair; Subramanian, Hariharan; Chen, Deryk

doi:10.1016/j.bjane.2018.12.012

Cited by 12 publications

(30 citation statements)

References 27 publications

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“…Conflicting results have been reported, depending on whether elective or emergency surgery was performed. In a 2006 study, Lepouse et al [18] found that emergency surgery did not affect the incidence of EA; in a 2019 study, Ramroop et al [40] found that emergency surgery increased the risk of postoperative EA, compared to elective surgery. The authors speculated that greater anxiety and uncorrected physiological derangements may have contributed to the increased incidence of EA in patients undergoing emergency surgery.…”

Section: Surgerymentioning

confidence: 99%

Section: Proposed Risk Factors For Emergence Agitationmentioning

confidence: 99%

“…Radtke et al [21] reported that EA more frequently affected younger (18 -39 years) and older (≥ 65 years) patients, compared to middle-aged (40 -64 years) patients. In a recent study of EA after sevoflurane anesthesia, age ≥ 65 years was significantly associated with EA [40]. Age-related changes in physiology can cause differences or increases in drug sensitivity and toxicity in elderly patients, compared to young adults [51,52].…”

Section: Agementioning

confidence: 99%

“…The duration of anesthesia changes with the duration of surgery; therefore, the two are closely related to each other. Caution is needed when interpreting most studies that suggest a longer duration of surgery or anesthesia is a risk factor for EA; only one of these parameters (i.e., anesthesia time or surgery time) may have been measured and analyzed in a given study [18,40,41].…”

Section: Duration Of Surgery/anesthesiamentioning

confidence: 99%

“…Nitrous oxide is an inhalational anesthetic agent commonly used in general anesthesia as an adjunct to other inhalational anesthetics; its use is reportedly not associated with EA [21,40].…”

Section: Inhalational Anestheticsmentioning

confidence: 99%

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Emergence agitation: current knowledge and unresolved questions

Lee

Sung

2020

Korean J Anesthesiol

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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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Section: Surgerymentioning

confidence: 99%

Section: Proposed Risk Factors For Emergence Agitationmentioning

confidence: 99%

Section: Agementioning

confidence: 99%

Section: Duration Of Surgery/anesthesiamentioning

confidence: 99%

Section: Inhalational Anestheticsmentioning

confidence: 99%

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Emergence agitation: current knowledge and unresolved questions

Lee

Sung

2020

Korean J Anesthesiol

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Emergence delirium is associated with increased postoperative delirium in elderly: a prospective observational study

Zhang

Nie

et al. 2020

J Anesth

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Background The clinical significance of emergence delirium remains unclear. The purpose of this study was to investigate the association between emergence delirium and postoperative delirium in elderly after general anesthesia and surgery. Methods This prospective observational study was done in a tertiary hospital in Beijing, China. Elderly patients (65–90 years) who underwent major noncardiac surgery under general anesthesia and admitted to the postanesthesia care unit (PACU) after surgery were enrolled. Emergence delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit during PACU stay. Postoperative delirium was assessed with the Confusion Assessment Method during the first 5 postoperative days. The association between emergence delirium and postoperative delirium was analyzed with a multivariable logistic regression model. Results A total of 942 patients were enrolled and 915 completed the study. Emergence delirium developed in 37.0% (339/915) of patients during PACU stay; and postoperative delirium developed in 11.4% (104/915) of patients within the first 5 postoperative days. After adjusted confounding factors, the occurrence of emergence delirium is independently associated with an increased risk of postoperative delirium (OR 1.717, 95% CI 1.078–2.735, P = 0.023). Patients with emergence delirium stayed longer in PACU and hospital after surgery, and developed more non-delirium complications within 30 days. Conclusions Emergence delirium in elderly admitted to the PACU after general anesthesia and major surgery is independently associated with an increased risk of postoperative delirium. Patients with emergence delirium had worse perioperative outcomes. Chinese Clinical Trial Registry (chictr.org.cn) ChiCTR-OOC-17012734

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Farmacogenômica do sevoflurano: papel no delirium do despertar

Nair

2019

Brazilian Journal of Anesthesiology

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Emergence delirium following sevoflurane anesthesia in adults: prospective observational study

Cited by 12 publications

References 27 publications

Emergence agitation: current knowledge and unresolved questions

Emergence agitation: current knowledge and unresolved questions

Emergence delirium is associated with increased postoperative delirium in elderly: a prospective observational study

Farmacogenômica do sevoflurano: papel no delirium do despertar

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