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

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: anaesthesia, emergence delirium; anaesthesia, general; complication, postoperative; complications, pulmonary; recovery period.