Patient Safety

Abstract Submission

Emergence Delirium in Patients with Post-Traumatic Stress Disorder: Best Practices (1 Class A CE with .25 Pharm)

Speaker(s)

• 

  Nancy Sweet-Fitzgibbon, MSN, APRN-CRNA

  Associate Faculty, Staff Nurse Anesthetist
  OU Medicine
  Edmond, OK
• 

  Anne-Marie Somerville, MSN, CRNA

  Clinical Instructor/CRNA
  Wake Forest University Baptist Medical Center
  Lexington, North Carolina

Adult patients awakening from general anesthesia may experience emergence delirium (EDL). The elderly, children, patients diagnosed with post-traumatic stress disorder, traumatic brain injury, or anxiety, as well as post-cardiac bypass, represent populations at higher risk for EDL. Post-traumatic stress disorder (PTSD) is thought to be a strong independent predictor of emergence delirium. Best practices to decrease EDL occurrence currently exist within pediatric anesthesia literature. A gap in evidence exists for adults with PTSD. Emergence delirium potentially places both the patient and providers in danger. An increased risk of injury to the patients and staff exists for confused, disoriented or combative patients. Routine postoperative care including analgesia becomes secondary to preventing injury to and from the patient. For patients with PTSD, EDL-related psychic trauma added to the physical dangers increases the potential for long-term injury. Providing anesthetic care using the best practices to decrease delirium will protect providers and enable more patients with PTSD to experience anesthesia without additional trauma.

Learning Objectives:

• Define emergence delirium characteristics and potential for harm to patient and providers.
• Describe post-traumatic stress disorder (PTSD) and its correlation to emergence delirium occurrence.
• Summarize the current state of the evidence related to emergence delirium in adult patients with PTSD.
• Describe the pharmacology of the medications currently suggested to decrease EDL including their contraindications, clinical use, mechanisms of action, physiological effects, and major adverse effects.
• Describe anesthetic techniques and plans to decrease emergence delirium in adult patients with PTSD.