Anaesthetic emergence agitation after cardiac surgery: An intensive care staff survey

Abstract

Background: Anecdotal reports suggest that during emergence from anaesthesia, some post-cardiac surgery patients exhibit signs of agitation with concerning clinical features, including hypoxaemia, ventilation dysynchrony, and haemodynamic instability. This clinical phenomenon has not been described in the published literature.

Objective: We aimed to investigate the perceptions and practice of intensive care unit staff members who have managed adult patients after cardiac surgery regarding emergence agitation, its clinical features, and treatment.

Methods: A descriptive survey was conducted from December 2020 to January 2021 in two metropolitan hospitals. Items included Likert scale, multiple-item selection, and free-text responses.

Results: There were 144 respondents (response rate: 55%). Post-cardiac surgery emergence agitation was witnessed by 143 respondents (99%). Fifty-seven (40%) reported encountering this clinical problem often. Clinical concerns included instabilities with airway or ventilation (347 items selected), cardiovascular system (189 items selected), and patient treatment interference, such as pulling tubes (229 items selected). Overall, 143 (99%) respondents re-sedated patients with emergence agitation, 138 (96%) added a narcotic bolus, and 121 respondents reported use of mechanical restraints (84%). Twenty-four respondents (2%) recalled receiving any formal anaesthetic emergence education, including after cardiac surgery.

Conclusion: Anaesthetic emergence agitation following cardiac surgery is a concerning clinical problem. Clinical management of emergence agitation was influenced more by clinical experience than research evidence. Further observational research is required to investigate clinical characteristics and inform evidence-based management practices and education.

Keywords: Anaesthetic emergence agitation; Cardiac surgery; Doctors; Intensive care unit; Nurses; Sedation; Sedation weaning.