Adult Emergence Agitation: A Veteran-Focused Narrative Review.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing existing literature without systematic search methodology.
PubMed 33177329 · doi:10.1213/ANE.0000000000005211
What was done
This narrative review synthesized literature on adult emergence agitation (EA), examining diagnostic boundaries, theoretical mechanisms, risk factors, preventative strategies, and veteran-specific perioperative management.
What was found
The reported incidence of EA in adult noncardiac surgery is approximately 19%. Limited data indicate that young adults undergoing otolaryngology procedures with volatile anesthetic maintenance may have the highest risk. Supplemental dexmedetomidine and ketamine were cited as potential preventive pharmacotherapies. Empirical data confirming elevated EA rates and the efficacy of prophylactic interventions specifically in military veterans with posttraumatic stress disorder remain limited.
Why it matters
The review provides a framework to distinguish self-limited emergence agitation from postoperative delirium and outlines non-pharmacologic grounding and trigger-avoidance tactics for high-risk surgical populations.
Limits
As a narrative review, it lacks a systematic search and quantitative synthesis. The underlying evidence base is limited by small sample sizes, conflicting diagnostic criteria, variable definitions of the emergence period, heterogeneous surgical cohorts, and a lack of validated veteran-specific data.
Cited by
- context Well-muscled young men under age 30 frequently experience emergence delirium upon waking up from anesthesia.