Agitation in adults in the post-anaesthesia care unit after general anaesthesia.
Level 4 - case-series / case-control
Matched case-control study
PubMed 30336849 · doi:10.1016/j.bja.2018.07.017
What was done
A 1:1 matched case-control study identified adult patients experiencing agitation (defined as Richmond Agitation-Sedation Scale score +3 or +4, or administration of haloperidol) in the post-anaesthesia care unit (PACU) after general anaesthesia between July 2010 and September 2016. Cases were matched to controls by age, sex, and surgical procedure. Multivariable logistic regression was used to evaluate associated patient and procedural factors.
What was found
Agitation occurred in 510 patients, an incidence of 2.5 cases per 1,000 patients (95% CI: 2.3–2.7). Factors independently associated with agitation were: - Postoperative tracheal tube (OR: 16.6; 95% CI: 7.25–38.2; P<0.001) - Urinary catheter (OR: 7.25; 95% CI: 4.31–12.2; P<0.001) - Substance misuse (OR: 6.77; 95% CI: 1.23–37.2; P=0.03) - Cognitive impairment (OR: 4.66; 95% CI: 1.79–12.1; P=0.002) - Nasogastric tube (OR: 4.06; 95% CI: 1.51–10.9; P=0.006) - Chest tube (OR: 3.46; 95% CI: 1.07–11.2; P=0.006) - Obesity (OR: 2.49; 95% CI: 1.66–3.73; P<0.001) - Psychiatric problems (OR: 2.05; 95% CI: 1.32–3.19; P=0.002) - Fall risk (OR: 1.66; 95% CI: 1.02–2.70; P=0.04) Agitated patients had higher rates of postoperative delirium (16.1% vs 6.3%; P<0.001) and pulmonary complications (9.8% vs 4.7%; P=0.002) than matched controls.
Why it matters
Recognizing that invasive postoperative devices and underlying mental health vulnerabilities are linked to emergence agitation can guide targeted PACU staffing and resource allocation to prevent harm.
Limits
The case-control design precludes causal inference. Defining cases in part by haloperidol administration may introduce treatment-selection bias. Several confidence intervals (e.g., substance misuse, tracheal tube) were wide, indicating imprecision. Specific anaesthetic agents and pain levels were not reported in the abstract.
Cited by
- context Well-muscled young men under age 30 frequently experience emergence delirium upon waking up from anesthesia.