From the Department of Anesthesiology, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota.
Department of Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota.
Anesth Analg. 2021 Feb 1;132(2):353-364. doi: 10.1213/ANE.0000000000005211.
Emergence agitation (EA) is a self-limited state of psychomotor excitement during awakening from general anesthesia. EA is confined to the emergence period as consciousness is restored, which sharply distinguishes it from other postoperative delirium states. Sporadic episodes of EA may become violent with the potential for harm to both patients and caregivers, but the long-term consequences of such events are not fully understood. Current literature on EA in adults is limited to small-scale studies with inconsistent nomenclature, variable time periods that define emergence, a host of different surgical populations, and conflicting diagnostic criteria. Therefore, true incidence rates and risk factors are unknown. In adult noncardiac surgery, the incidence of EA is approximately 19%. Limited data suggest that young adults undergoing otolaryngology operations with volatile anesthetic maintenance may be at the highest risk for EA. Currently suggested EA mechanisms are theoretical but might reflect underblunted sympathetic activation in response to various internal (eg, flashbacks or anxiety) or external (eg, surgical pain) stimuli as consciousness returns. Supplemental dexmedetomidine and ketamine may be utilized for EA prevention. Compared to the civilian population, military veterans may be more vulnerable to EA due to high rates of posttraumatic stress disorder (PTSD) manifesting as violent flashbacks; however, confirmatory data are limited. Nonetheless, expert military medical providers suggest that use of patient-centered rapport tactics, PTSD trigger identification and avoidance, and grounding measures may alleviate hyperactive emergence phenomena. Future research is needed to better characterize EA in veterans and validate prophylactic measures to optimize care for these patients. This narrative review provides readers with an important framework to distinguish EA from delirium. Furthermore, we summarize current knowledge of EA risk factors, mechanisms, and adult management strategies and specifically revisit them in the context of veteran perioperative health. The anesthesiology care team is ideally positioned to further explore EA and develop effective prevention and treatment protocols.
术后躁动（EA）是全身麻醉苏醒期出现的一种短暂的精神运动兴奋状态。EA 仅限于意识恢复期间的苏醒期，这使其与其他术后谵妄状态明显不同。EA 可能会间歇性地变得剧烈，从而对患者和护理人员造成潜在的伤害，但此类事件的长期后果尚未完全了解。目前关于成人 EA 的文献仅限于小规模研究，其命名不统一，定义苏醒的时间范围不同，涉及多种不同的手术人群，且诊断标准也存在差异。因此，确切的发病率和危险因素尚不清楚。在成人非心脏手术中，EA 的发病率约为 19%。有限的数据表明，接受挥发性麻醉维持的耳鼻喉手术的年轻成年人发生 EA 的风险最高。目前提出的 EA 机制是理论上的，但可能反映了意识恢复时对各种内部（例如，闪回或焦虑）或外部（例如，手术疼痛）刺激的交感神经激活不足。可使用辅助性右美托咪定和氯胺酮预防 EA。与平民人群相比，由于创伤后应激障碍（PTSD）的发生率较高，退伍军人可能更容易发生 EA，表现为剧烈的闪回；但是，证实性数据有限。尽管如此，专业的军事医疗服务提供者认为，使用以患者为中心的融洽关系策略、识别和避免 PTSD 触发因素以及基础措施可能会缓解过度活跃的苏醒现象。需要进一步的研究来更好地描述退伍军人中的 EA，并验证预防措施，以优化对这些患者的护理。本综述为读者提供了一个重要的框架，用于区分 EA 和谵妄。此外，我们总结了 EA 的危险因素、机制和成人管理策略的现有知识，并特别在退伍军人围手术期健康的背景下重新审视了这些知识。麻醉护理团队最适合进一步探索 EA 并制定有效的预防和治疗方案。
