Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit
Autor: | J. Wood, Christopher G. Hughes, Eugene Wesley Ely, Amy J. Graves, E. Card, C. Tomes, Pratik P. Pandharipande, A. Shintani, D. Nelson, C. Lee |
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Jazyk: | angličtina |
Rok vydání: | 2014 |
Předmět: |
Adult
Male Critical Care Anesthesia General behavioral disciplines and activities Pacu law.invention Clinical Practice Postoperative Complications law Risk Factors mental disorders Medicine Humans General anaesthesia In patient Prospective Studies Psychomotor Agitation Aged biology business.industry Delirium New Orleans Perioperative Length of Stay Middle Aged biology.organism_classification Intensive care unit nervous system diseases Intensive Care Units Anesthesiology and Pain Medicine Anesthesia Concomitant Assessment methods Anesthesia Recovery Period Female medicine.symptom business |
Popis: | Background Emergence from anaesthesia is often accompanied by signs of delirium, including fluctuating mental status and inattention. The evolution of these signs of delirium requires investigation since delirium in the post-anaesthesia care unit (PACU) may be associated with worse outcomes. Methods Adult patients emerging from anaesthesia were assessed for agitated emergence in the operating room using the Richmond Agitation-Sedation Scale (RASS). The Confusion Assessment Method for the Intensive Care Unit was then used to evaluate delirium signs at PACU admission and during PACU stay at 30 min, 1 h, and discharge. Signs consistent with delirium were classified as hyperactive vs hypoactive based upon a positive CAM-ICU assessment and the concomitant RASS score. Multivariable logistic regression was utilized to assess potential risk factors for delirium during PACU stay including age, American Society of Anesthesiologists classification, and opioid and benzodiazepine exposure. Results Among 400 patients enrolled, 19% had agitated emergence. Delirium signs were present at PACU admission, 30 min, 1 h, and PACU discharge in 124 (31%), 59 (15%), 32 (8%), and 15 (4%) patients, respectively. In patients with delirium signs, hypoactive signs were present in 56% at PACU admission and in 92% during PACU stay. Perioperative opioids were associated with delirium signs during PACU stay (P=0.02). Conclusions A significant proportion of patients develop delirium signs in the immediate postoperative period, primarily manifesting with a hypoactive subtype. These signs often persist to PACU discharge, suggesting the need for structured delirium monitoring in the PACU to identify patients potentially at risk for worse outcomes in the postoperative period. |
Databáze: | OpenAIRE |
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