Tropical Journal of Pharmaceutical Research

Original Research Article | OPEN ACCESS

Delirium complications in post-general anesthesia: An observational study in China

Fei Fei¹, Shan Yu²

¹Department of Anesthesiology, the Affiliated Huaiâ€™an Hospital of Xuzhou Medical University, Huaiâ€™an, Jiangsu 223001; ²Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China.

For correspondence:- Shan Yu Email: SherryrHillsk@yahoo.com Tel:+862784309778

Accepted: 14 January 2019 Published: 28 February 2019

Citation: Fei F, Yu S. Delirium complications in post-general anesthesia: An observational study in China. Trop J Pharm Res 2019; 18(2):385-390 doi: 10.4314/tjpr.v18i2.23

© 2019 The authors.
This is an Open Access article that uses a funding model which does not charge readers or their institutions for access and distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0) and the Budapest Open Access Initiative (http://www.budapestopenaccessinitiative.org/read), which permit unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited..

Abstract

Purpose: To evaluate emergence agitation and delirium signs in general anesthesia (GA) and post-anesthesia care units (PACUs), and associated risk factors.

Methods: Adult patients (n = 380) exposed to GA were recruited over a period of 1 year and five months for this study, and were assessed for emergence delirium (ED) using Richmond Agitation-Sedation Scale (RASS). Confusion Assessment Method for Intensive Care Unit (CAM-ICU) was used to assess delirium signs on admission to, and during stay in PACU at 30 min, 1 h, and at discharge. Signs consistent with delirium were classified as hyperactive or hypoactive based on a positive CAM-ICU assessment and RASS score. Multivariable logistic regression was used to assess potential risk factors for delirium such as age, American Society of Anesthesiologists (ASA) classification, and opioid and benzodiazepine (BZD) exposure during stay in PACU.

Results: Emergence delirium (ED) occurred in 69 (18.2 %) patients out of which 41 (59.4 %) were also CAM-ICU +ve on admission to PACU, with 22 (31.9 %), 11 (15.9 %), and 6 (8.7 %) CAM-ICU +ve at 30 min, 1 h, and at discharge from PACU, respectively. Therefore, 28 (7.4 %) patients had ED with no associated signs of delirium. A total of 117 (30.8 %) patients had signs of delirium (CAM-ICU +ve) during admission to PACU, 58.1 % of whom had hypoactive features based on their RASS scores. Signs of delirium during stay in PACU were observed in 64 (16.8 %) patients, while 61 (16.1 %), 28 (7.4 %), and 14 (3.7 %) patients were CAM-ICU +ve at 30 min, 1 h, and at discharge from PACU, respectively. The results of multivariate logistic regression showed that total perioperative opioid administration (fentanyl equivalent) was independently associated with signs of delirium during stay in PACU, after relevant covariate adjustment (p = 0.03). However, age, BZD exposure (midazolam equivalent), and ASA classification did not show significant association with signs of delirium during stay at PACU. The result of sensitivity analysis showed that duration of anesthesia was independently associated with signs of delirium during stay in PACU.

Conclusion: The results of this study suggest that in patients undergoing GA, signs of delirium are common in the immediate postoperative period, with incidence highest on arrival at the PACU and decreasing gradually during stay in PACU. Hypoactive features are common and more prominent during stay in PACU, when compared to hyperactive features.

Keywords: Emergence delirium, Anesthesia, Post-anesthesia care unit, Hypoactive features, Association