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 11 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.