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
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References
- Postoperative critical care of the adult cardiac surgical patient. Part I: routine postoperative care.Crit Care Med. 2015 Jul; 43 (PMID: 25962078): 1477-1497https://doi.org/10.1097/CCM.0000000000001059
- Postoperative critical care of the adult cardiac surgical patient: Part II: procedure-specific considerations, management of complications, and quality improvement.Crit Care Med. 2015 Sep; 43 (PMID: 26136101): 1995-2014https://doi.org/10.1097/CCM.0000000000001171
- Adult emergence agitation: a veteran-focused narrative review.Anesth Analg. 2021 Feb 1; 132 (PMID: 33177329): 353-364https://doi.org/10.1213/ANE.0000000000005211
- The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients.Am J Respir Crit Care Med. 2002 Nov 15; 166 (PMID: 12421743): 1338-1344https://doi.org/10.1164/rccm.2107138
- Emergence agitation: current knowledge and unresolved questions.Korean J Anesthesiol. 2020 Dec; 73 (Epub 2020 Mar 25. PMID: 32209961; PMCID: PMC7714637): 471-485https://doi.org/10.4097/kja.20097
- Agitation in adults in the post-anaesthesia care unit after general anaesthesia.Br J Anaesth. 2018 Nov; 121 (Epub 2018 Aug 31. PMID: 30336849): 1052-1058https://doi.org/10.1016/j.bja.2018.07.017
- An introductory guide to survey research in anaesthesia.Anaesth Intensive Care. 2006 Apr; 34 (PMID: 16617649): 245-253https://doi.org/10.1177/0310057X0603400219
- Foundations of Mixed Methods Research. Integrating quantitative and qualitative approaches in the social and behavioral sciences.Sage, 2021
- Lavrakas P.J. Encyclopedia of survey research methods. Sage Publications, Inc, Thousand Oaks, CA2008https://doi.org/10.4135/9781412963947 ([cited 2021 Oct 6])
- Using thematic analysis in psychology.Qual Res Psychol. 2006 Jan 1; 3: 77-101
Research Electronic Data capture, projectredcap.org.
- Likert scales: how to (ab)use them.Med Educ. 2004 Dec; 38 (x. PMID: 15566531): 1217-1218https://doi.org/10.1111/j.1365-2929.2004.02012
Social Science Statistics. https://www.socscistatistics.com/tests.
- Guideline 11.1: introduction to and principles of in-hospital resuscitation.2019 (arc-guideline-11-1-introduction-to-and-principles-of-in-hospital-resuscitation_feb-2019%20(1).pdf)
- Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.Int J Qual Health Care. 2007 Dec; 19 (Epub 2007 Sep 14. PMID: 17872937): 349-357https://doi.org/10.1093/intqhc/mzm042
- Declaration of Madrid: position statement on the preparation of critical care nurses.World Federation of Nurses position statement, 2005 ([internet])
- ACCCN position statement on the provision of critical care nurse education.([Internet])2006
ANZCA The Anaesthesia Training Program Curriculum [internet] ANZCA-curriculum-v1-10-May-2021.pdf.
- Structures, processes and outcomes of specialist critical care nurse education: an integrative review.Aust Crit Care. 2019 Jul; 32 (Epub 2018 Dec 6. PMID: 30528560): 331-345https://doi.org/10.1016/j.aucc.2018.09.007
- Protocolized intensive care unit management of analgesia, sedation, and delirium improves analgesia and subsyndromal delirium rates.Anesth Analg. 2010 Aug; 111 (Epub 2010 Apr 7): 451-463https://doi.org/10.1213/ANE.0b013e3181d7e1b8
- PS09, PS18, PS55 Australian New Zealand college of anaesthetists (ANZCA).2019 ([cited 2021 October 6])
- A competency-based curriculum for critical care nurse practitioners' transition to practice.Am J Crit Care. 2018 Sep; 27 (PMID: 30173173): 398-406https://doi.org/10.4037/ajcc2018101
- The important role of simulation in sedation.Curr Opin Anesthesiol. 2016; 29 (PubMed PMID: 00001503-201603001-00002): S14-S20https://doi.org/10.1097/aco.0000000000000313
- Study design, precision, and validity in observational studies.J Palliat Med. 2009 Jan; 12 (PMID: 19284267; PMCID: PMC2920077): 77-82https://doi.org/10.1089/jpm.2008.9690
Article info
Publication history
Published online: October 28, 2022
Accepted:
August 28,
2022
Received in revised form:
August 23,
2022
Received:
November 17,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
