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Ranegar, Taylor P
Digital Commons - Otterbein (Otterbein University). 2026 May 4.
Emergence agitation (EA) is a post-anesthetic complication that occurs when the patient is in a self-limited, nonfluctuating state of excitement while transitioning into a state of consciousness. EA can lead to negative adverse outcomes including, accidental invasive line removal, bleeding, respiratory depression, unintentional extubation, and injury to the staff and the patient. EA is often observed in military veterans who have a medical history of post-traumatic stress disorder (PTSD). For patients with a history of military exposure undergoing elective general anesthesia who also have PTSD, anxiety, and or depression, the incidence of EA was estimated to be around 27%. The pathophysiology of EA is unknown; however, a collection of risk factors has been associated with a higher incidence of EA. These risk factors include pre-operative anxiety, history of pre-existing mental disorders like PTSD, use of volatile agents with low solubility, age, sex, invasive lines and tubes, and the use of premedications like benzodiazepines and anticholinergics.There are currently no evidence-based guidelines or policies in place to properly manage and prevent the incidence of EA in military veterans with a history of PTSD scheduled for general anesthesia. Dexmedetomidine is an alpha-2 adrenoceptor agonist that produces sedation that resembles a patient's natural sleep without causing respiratory depression and allowing for patient arousal. The combination of high-risk identifying assessment tools including the DSM-5, the Richmond Agitation Sedation Scale (RASS), and the utilization of Dexmedetomidine in the peri-operative setting has been proven to decrease the incidence of EA in patients with a history of PTSD.
苏醒期躁动（EA）是一种麻醉后并发症，发生于患者在向意识状态转变时处于一种自限性、无波动的兴奋状态。EA可导致不良后果，包括意外拔除侵入性管路、出血、呼吸抑制、意外拔管以及对医护人员和患者的伤害。EA常在有创伤后应激障碍（PTSD）病史的退伍军人中观察到。对于有军事暴露史且患有PTSD、焦虑症和/或抑郁症并接受择期全身麻醉的患者，EA的发生率估计约为27%。EA的病理生理学尚不清楚；然而，一系列风险因素与EA的较高发生率相关。这些风险因素包括术前焦虑、PTSD等既往精神障碍病史、使用低溶解度的挥发性麻醉剂、年龄、性别、侵入性管路和导管，以及使用苯二氮䓬类和抗胆碱能药物等术前用药。目前尚无基于证据的指南或政策来妥善管理和预防计划接受全身麻醉的有PTSD病史的退伍军人中EA的发生。右美托咪定是一种α-2肾上腺素能受体激动剂，可产生类似于患者自然睡眠的镇静作用，不会引起呼吸抑制并允许患者苏醒。包括《精神疾病诊断与统计手册》第5版（DSM-5）、里士满躁动镇静量表（RASS）在内的高风险识别评估工具的组合，以及在围手术期使用右美托咪定，已被证明可降低有PTSD病史患者的EA发生率。
