Risk factors of inadequate emergence following general anesthesia with an emphasis on patients with substance dependence history.
BACKGROUND
This study aims to define the incidence and risk factors of both emergence agitation and hypoactive emergence in adult patients and substance-dependent patients following general anesthesia to elaborate on the risk factors and precise management of them.


METHODS
The study recruited 1,136 adult patients who received elective surgeries under general anesthesia for this prospective observational study. Inadequate emergence was determined according to the Richmond Agitation-Sedation Scale (RASS). Emergence agitation was defined as a RASS ≥ +1 point, and hypoactive emergence was defined as a RASS ≤ -2 points. Subgroup analyses were then conducted on patients with substance dependence.


RESULTS
Inadequate emergence in the post-anesthesia care unit (PACU) occurred in 20.3% of patients, including 13.9% with emergence agitation and 6.4% with hypoactive emergence. Ninety-five patients had a history of substance dependence. Compared to divorced patients, never-married and presently married patients, who underwent gynecological and thoracic surgeries, had a lower risk of agitation. Neurologic disorders, intraoperative blood loss, intraoperative morphine, and PACU analgesic drug administration were associated with increased agitation risk. Hypertension and psychological disorders, intraoperative opioids, and PACU Foley catheter fixation were associated with increased hypoactive emergence risk. Substance-dependent patients had higher risk for agitation (21.1%, P = 0.019) and hypoactive emergence (10.5%, P = 0.044).


CONCLUSIONS
Inadequate emergence in PACU following general anesthesia is a significant problem correlated with several perioperative factors. Patients with a history of substance dependence appear to be more at risk of inadequate emergence than the general population.
['Makarem|Jalil|J|', 'Larijani|Amir Hossein|AH|', 'Eslami|Babak|B|', 'Jafarzadeh|Afshin|A|', 'Karvandian|Kasra|K|', 'Mireskandari|Seyed Mohammad|SM|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D000768:Anesthesia, General D055191:Delayed Emergence from Anesthesia D017558:Elective Surgical Procedures D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011446:Prospective Studies D012307:Risk Factors D019966:Substance-Related Disorders D055815:Young Adult
General anesthesia Substance dependence Emergence agitation Hypoactive emergence Elective surgery Post anesthesia care unit