Agitation in adults in the post-anaesthesia care unit after general anaesthesia

• Published in: British journal of anaesthesia : BJA Vol. 121; no. 5; pp. 1052 - 1058
• Main Authors: Fields, A., Huang, J., Schroeder, D., Sprung, J., Weingarten, T.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.11.2018
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; anaesthesia, emergence delirium; anaesthesia, general; Anesthesia Recovery Period; Anesthesia, General - adverse effects; Case-Control Studies; Catheters, Indwelling - adverse effects; Cognition Disorders - complications; complication, postoperative; complications, pulmonary; Emergence Delirium - epidemiology; Female; Humans; Incidence; Intubation, Intratracheal - adverse effects; Lung Diseases - epidemiology; Lung Diseases - etiology; Male; Mental Disorders - complications; Middle Aged; Obesity - complications; Postoperative Complications - epidemiology; Psychomotor Agitation - epidemiology; recovery period; Recovery Room; Retrospective Studies; Risk Factors; Substance-Related Disorders - complications; Young Adult; complications, pulmonary; anaesthesia, general; anaesthesia, emergence delirium; recovery period; complication, postoperative
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1016/j.bja.2018.07.017

Agitation after general anaesthesia can lead to self-harm, violence against staff, and increased resource utilisation. We aimed to assess patient and procedural characteristics associated with this complication in adults. We identified cases of agitation (Richmond Agitation–Sedation Scale score +3 or +4, or administration of haloperidol) in patients after general anaesthesia in the PACU from July 1, 2010 to September 30, 2016. The cases were matched 1:1 with control patients without agitation by age, sex, and procedure. Potential clinical associations were assessed with a multivariable analysis. We identified agitation in 510 patients [incidence: 2.5 cases/1000 patients; 95% confidence interval (CI): 2.3–2.7]. Variables associated with agitation were substance misuse [odds ratio (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), 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), postoperative presence of a tracheal tube (OR: 16.6; 95% CI: 7.25–38.2; P<0.001), urine catheter (OR: 7.25; 95% CI: 4.31–12.2; P<0.001), nasogastric tube (OR: 4.06; 95% CI: 1.51–10.9; P=0.006), or chest tube (OR: 3.46; 95% CI: 1.07–11.2; P=0.006). Compared with control patients, more agitated patients had postoperative delirium (16.1% vs 6.3%; P<0.001) and pulmonary complications (9.8% vs 4.7%; P=0.002). Agitation after general anaesthesia was associated with postoperative indwelling catheters, tracheal intubation and patient features suggestive of pre-existing mental health problems. Anticipation of high-risk patients could allow allocation of staffing resources to provide a safe environment for anaesthetic recovery.