Inadequate emergence after anesthesia for elective cancer surgery: a single-center cohort study
Despertar inadequado após anestesia para cirurgia eletiva de câncer: um estudo de coorte de centro único
André Braga; Fernando Abelha
Abstract
Background
Inadequate emergence after anesthesia (IEA) is a common phenomenon in adult patients undergoing anesthesia. The aim of this study was to evaluate the incidence and determinants of IEA for elective cancer surgery, and to study its influence on the quality of recovery.
Methods
In this observational, prospective study, 148 patients scheduled for elective cancer surgery were included. IEA was considered for patients having emergence delirium or hypoactive emergence applying The Richmond Agitation and Sedation Scale (RASS) 10 minutes after admission at PACU. Postoperative Quality of Recovery Scale (PQRS) was used at baseline and after surgery at minutes 15 (T15) and 40 (T40), and days 1 (D1) and 3 (D3).
Results
Of the 148 patients, 48 (32%) had IEA. Complete recovery at PQRS was less frequent in patients with IEA on physiological domain at T15 and D1, and activities of daily living domain at D3. Patients with IEA recovered more frequently in emotive domain at T15, T40, and D3. Determinants of IEA were age, risk of surgery, congestive heart disease, cerebrovascular disease, ASA physical status, RCRI score, and duration of anesthesia. IEA patients had more frequently postoperative delirium and stayed for longer at PACU and at the hospital.
Conclusion
IEA was a common phenomenon after anesthesia for elective curative surgery for cancer. Patients with IEA were older and had more comorbidities and a higher surgical risk. Patients with IEA had a less frequent complete recovery on the PD and in AD domains, and a more frequent complete recovery on the ED.
Keywords
Resumo
Justificativa: O despertar inadequado após a anestesia (DIAA) é um fenômeno comum em pacientes adultos submetidos à anestesia. O objetivo deste estudo foi avaliar a incidência e os determinantes do DIAA para cirurgia oncológica eletiva e estudar sua influência na qualidade da recuperação. Métodos: Neste estudo observacional e prospectivo, 148 pacientes agendados para cirurgia eletiva de câncer foram incluídos. O DIAA foi considerado para pacientes com delírio ao despertar ou despertar hipoativo, aplicando-se a Escala de Agitação e Sedação de Richmond (RASS) 10 minutos após a admissão na SRPA. A Escala de Qualidade de Recuperação Pós-Operatória (PQRS) foi usada no início e após a cirurgia nos minutos 15 (T15) e 40 (T40) e nos dias 1 (D1) e 3 (D3). Resultados: Dos 148 pacientes, 48 (32%) apresentaram DIAA. A recuperação completa no PQRS foi menos frequente nos pacientes com DIAA no domínio fisiológico em T15 e D1 e no domínio atividades de vida diária em D3. Pacientes com DIAA se recuperaram mais frequentemente no domínio emotivo em T15, T40 e D3. Determinantes de DIAA foram idade, risco de cirurgia, doença cardíaca congestiva, doença cerebrovascular, estado físico ASA, pontuação RCRI e duração da anestesia. Os pacientes com DIAA apresentaram delirium pós-operatório com maior frequência e permaneceram mais tempo na SRPA e no hospital. Conclusão: DIAA foi um fenômeno comum após anestesia para cirurgia curativa eletiva para câncer. Os pacientes com DIAA eram mais velhos e apresentavam mais comorbidades e maior risco cirúrgico. Os pacientes com DIAA tiveram uma recuperação completa menos frequente nos domínios DP e AD e uma recuperação completa mais frequente no ED.
Palavras-chave
References
1 F.M. Radtke, M. Franck, L. Hagemann, et al. Risk factors for inadequate emergence after anesthesia: emergence delirium and hypoactive emergence Minerva Anestesiol., 76 (2010), pp. 394-403
2 D. Wiinholdt, S.A.N. Eriksen, L.B. Harms, et al. Inadequate emergence after non-cardiac surgery-A prospective observational study in 1000 patients Acta Anaesthesiol Scand., 63 (2019), pp. 1137-1142
3 Z.N. Kain, A.A. Caldwell-Andrews, I. Maranets, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors Anesth Analg., 99 (2004), pp. 1648-1654
4 L. Munk, G. Andersen, A.M. Moller Post-anaesthetic emergence delirium in adults: incidence, predictors and consequences Acta Anaesthesiol Scand., 60 (2016), pp. 1059-1066
5 D. Xara, A. Silva, J. Mendonca, et al. Inadequate emergence after anesthesia: emergence delirium and hypoactive emergence in the Postanesthesia Care Unit J Clin Anesth., 25 (2013), pp. 439-446
6 Z. Liu Analysis of risk factors for emergence agitation in adults undergoing general anesthesia for nasal surgery Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi., 29 (2015), pp. 1881-1885
7 G.P. Vlajkovic, R.P. Sindjelic Emergence delirium in children: many questions, few answers Anesth Analg., 104 (2007), pp. 84-91
8 C. Lepouse, C.A. Lautner, L. Liu, et al. Emergence delirium in adults in the post-anaesthesia care unit Br J Anaesth., 96 (2006), pp. 747-753
9 D. Yu, W. Chai, X. Sun, et al. Emergence agitation in adults: risk factors in 2,000 patients Can J Anaesth., 57 (2010), pp. 843-848
10 K. Monson, D.A. Litvak, R.J. Bold Surgery in the aged population: surgical oncology Arch Surg., 138 (2003), pp. 1061-1067
11 M. Cicerchia, M. Ceci, C. Locatelli, et al. Geriatric syndromes in peri-operative elderly cancer patients Surg Oncol., 19 (2010), pp. 131-139
12 A.J. Bowyer, C.F. Royse Postoperative recovery and outcomes--what are we measuring and for whom? Anaesthesia., 71 (Suppl 1) (2016), pp. 72-77
13 A. Bowyer, C. Royse The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications Can J Anaesth., 63 (2016), pp. 176-183
14 K. Korttila Recovery from outpatient anaesthesia. Factors affecting outcome Anaesthesia., 50 (Suppl) (1995), pp. 22-28
15 R. Allvin, K. Berg, E. Idvall, et al. Postoperative recovery: a concept analysis J Adv Nurs., 57 (2007), pp. 552-558
16 L. Lee, T. Tran, N.E. Mayo, et al. What does it really mean to “recover” from an operation? Surgery., 155 (2014), pp. 211-216
17 A. Neville, L. Lee, I. Antonescu, et al. Systematic review of outcomes used to evaluate enhanced recovery after surgery Br J Surg., 101 (2014), pp. 159-170
18 M. Guerreiro, A.P. Silva, M. Botelho, et al. Adaptação à população portuguesa da tradução do Mini Mental State Examination [Adaptation of the Mini Mental State Examination translation for the Portuguese population] Rev Port Neurol., 1 (1994), pp. 9-10
19 L.A. Fleisher, J.A. Beckman, K.A. Brown, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery Circulation., 116 (2007), pp. e418-99
20 K. Rockwood, X. Song, C. MacKnight, et al. A global clinical measure of fitness and frailty in elderly people CMAJ., 173 (2005), pp. 489-495
21 M.A. Shulman, P.S. Myles, M.T. Chan, et al. Measurement of disability-free survival after surgery Anesthesiology., 122 (2015), pp. 524-536
22 C.N. Sessler, M.S. Gosnell, M.J. Grap, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients Am J Respir Crit Care Med., 166 (2002), pp. 1338-1344
23 J.D. Gaudreau, P. Gagnon, F. Harel, et al. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale J Pain Symptom Manage., 29 (2005), pp. 368-375
24 G.S. Murphy, J.W. Szokol, J.H. Marymont, et al. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit Anesth Analg., 107 (2008), pp. 130-137
25 H.J. Kim, D.K. Kim, H.Y. Kim, et al. Risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery Clin Exp Otorhinolaryngol., 8 (2015), pp. 46-51
26 O. Viswanath, B. Kerner, Y.-K. Jean, R. Soto Emergence delirium: a narrative review J Anesthesiol Clin Sci., 4 (2015), p. 2
27 E. Card, P. Pandharipande, C. Tomes, et al. Emergence from general anaesthesia and evolution of delirium signs in the post-anaesthesia care unit Br J Anaesth., 115 (2015), pp. 411-417
28 F.J. Abelha, C. Luis, D. Veiga, et al. Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery Crit Care., 17 (2013), p. R257
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email