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Emergence delirium after intracranial neurosurgery- a prospective cohort study

      Highlights

      • The incidence of emergence delirium is highest in the first hour after emergence from general anesthesia.
      • Emergence delirium after general anesthesia has two dimensions a) emergence agitation and b) emergence sedation.
      • Incidences of overall emergence delirium, emergence agitation and emergence sedation after intracranial surgery were 22%, 4.3% and 18% respectively.
      • Addressing modifiable risk factors may reduce incidence of emergence delirium.

      Abstract

      Objectives

      The primary objective of this study was to estimate the incidence of emergence delirium (ED) including hypo- and hyperactive ED, after intracranial neurosurgery. Secondary objective was to identify perioperative risk factors of ED in these patients.

      Methods

      This prospective observational study was conducted at an academic neurosciences hospital. All consecutive adult patients (age ≥ 18 years) with a preoperative Glasgow Coma Scale score of 15 undergoing elective intracranial surgery under general anesthesia during the six-month period from October 2020 to March 2021 were included in this study. Perioperative patient data were collected till one hour after surgery. ED was defined as per Riker’s sedation agitation score (SAS) as hyperactive ED when SAS was >4 and hypo active ED when SAS was <4 on a 1 to 7 scale.

      Results

      Data of 320 patients were analyzed in this study. The overall incidence of ED was 22 % (71/320), with incidence of hyperactive ED of 4.3 % (n = 14) and hypoactive ED of 18 % (n = 57). The risk factors for ED were preoperative delirium (odds ratio [OR], 95 % confidence interval [CI] and p value of 4.41, 1.3–15.19, and 0.002), education level (OR = 2.21, [0.98–4.94], p = 0.05), minimum alveolar concentration of inhalational anesthetic (OR = 1.47, [1.17–1.88], p = 0.002), postoperative nausea and vomiting (OR = 4.56, [2.04–10.32], p = 0.001), and body weight (OR = 1.69, [1.1–2.68], p = 0.02). Hyperactive ED was predicted by preoperative delirium (OR = 5.28, [1.12–21.21], p = 0.024) and low education level (OR = 4.35, [1.2–17.04], p = 0.027).

      Conclusions

      Atleast one in five patients undergoing brain surgery under anesthesia develop ED. Addressing modifiable risk factors might reduce ED.

      Keywords

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      References

      1. Mohkamkar M Bs, Farhoudi F Md, Alam-Sahebpour A Md, Mousavi SA Md, Khani S PhD, Shahmohammadi S BSc. Postanesthetic Emergence Agitation in Pediatric Patients under General Anesthesia. Iran J Pediatr 2014 Apr;24(2):184-90. PMID: 25535538; PMCID: PMC4268839.

        • Yu D.
        • Chai W.
        • Sun X.
        • Yao L.
        Emergence agitation in adults: risk factors in 2,000 patients.
        Canadian J Anesthesia. 2010; 57 (Epub 2010 Jun 5 PMID: 20526708): 843-848https://doi.org/10.1007/s12630-010-9338-9
        • Zainal Abidin H.
        • Omar S.C.
        • Mazlan M.Z.
        • Hassan M.H.
        • Isa R.
        • Ali S.
        • Hassan S.K.
        • Marzuki A.
        Postoperative maladaptive behavior, preoperative anxiety and emergence delirium in children undergone general anesthesia: a narrative review.
        Global Pediatric Health. 2021; 8 (10.1177/2333794X211007975 2333794X211007975. PMID: 33889680; PMCID: PMC8040608)
        • Lee S.-J.
        • Sung T.-Y.
        Emergence agitation: current knowledge and unresolved questions.
        Korean J Anesthesiol. 2020; 73 (Epub 2020 Mar 25. PMID: 32209961; PMCID: PMC7714637): 471-485https://doi.org/10.4097/kja.20097
        • Menser C.
        • Smith H.
        Emergence agitation and delirium: considerations for epidemiology and routine monitoring in pediatric patients.
        Local Regional Anesthesia. 2020; 27 (PMID: 32801855; PMCID: PMC7394591): 73-83https://doi.org/10.2147/LRA.S181459
        • Kim H.-J.
        • Kim D.-K.
        • Kim H.-Y.
        • Kim J.-K.
        • Choi S.-W.
        Risk factors of emergence agitation in adults undergoing general Anesthesia for nasal surgery.
        Clin Exp Otorhinolaryngol. 2015; 8 (Epub 2015 Feb 3. PMID: 25729495; PMCID: PMC4338091): 46https://doi.org/10.3342/ceo.2015.8.1.46
        • Kang X.
        • Lin K.
        • Tang H.
        • Tang X.
        • Bao F.
        • Gan S.
        • et al.
        Risk factors for emergence agitation in adults undergoing thoracoscopic lung surgery: a case-control study of 1,950 patients.
        J Cardiothorac Vasc Anesth. 2020; 34 (Epub 2020 Mar 2 PMID: 32418835): 2403-2409https://doi.org/10.1053/j.jvca.2020.02.046
        • Bharadwaj S.
        • Kamath S.
        • Chakrabarti D.
        • Shetty P.
        Incidence of and risk factors for emergence delirium and postoperative delirium in neurosurgical patients- A prospective cohort study.
        Neurol India. 2021; 69: 1579https://doi.org/10.4103/0028-3886.333461
      2. Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench. 2013 Winter;6(1):14-7. PMID: 24834239; PMCID: PMC4017493.

        • Chen L.
        • Xu M.
        • Li G.Y.
        • Cai W.X.
        • Zhou J.X.
        Incidence, risk factors and consequences of emergence agitation in adult patients after elective craniotomy for brain tumor: a prospective cohort study.
        PLoS One. 2014; 9 (PMID: 25493435; PMCID: PMC4262354)e114239https://doi.org/10.1371/journal.pone.0114239
        • Card E.
        • Tomes C.
        • Lee C.
        • Wood J.
        • Nelson D.
        • Graves A.
        • et al.
        Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit.
        Br J Anaesth. 2015; 115 (Epub 2014 Dec 23. PMID: 25540068; PMCID: PMC4533730): 411-417https://doi.org/10.1093/bja/aeu442
        • Wang C.M.
        • Huang H.W.
        • Wang Y.M.
        • He X.
        • Sun X.M.
        • Zhou Y.M.
        • et al.
        Incidence and risk factors of postoperative delirium in patients admitted to the ICU after elective intracranial surgery: a prospective cohort study.
        Eur J Anaesthesiol. 2020; 37 (PMID: 31464712): 14-24https://doi.org/10.1097/EJA.0000000000001074
        • Kim H.C.
        • Kim E.
        • Jeon Y.T.
        • Hwang J.W.
        • Lim Y.J.
        • Seo J.H.
        • et al.
        Postanaesthetic emergence agitation in adult patients after general anaesthesia for urological surgery.
        J Int Med Res. 2015; 43 (Epub 2015 Jan 30 PMID: 25637216): 226-235https://doi.org/10.1177/0300060514562489
        • Rim J.C.
        • Kim J.A.
        • Hong J.I.
        • Park S.Y.
        • Lee J.H.
        • Chung C.J.
        Risk factors of emergence agitation after general anesthesia in adult patients.
        Anesthesia Pain Med. 2016; 11: 410-416https://doi.org/10.17085/apm.2016.11.4.410
        • Wei B.
        • Feng Y.
        • Chen W.
        • Ren D.
        • Xiao D.
        • Chen B.
        Risk factors for emergence agitation in adults after general anesthesia: a systematic review and meta-analysis.
        Acta Anaesthesiol Scand. 2021; 65 (Epub 2021 Jan 7 PMID: 33370461): 719-729https://doi.org/10.1111/aas.13774