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Evidence-Based Management of Emergence Delirium in Adults with PTSD: A Scoping Review
Saleh Mizyed, RN, DNP, CRNA
DNP Nurse Anesthesia
Evidence-Based Management of Emergence Delirium in Adults with PTSD: A Scoping Review
Project Category: Evidence Implementation
Project Team: Saleh Mizyed, DNP, CRNA Erick McCormick, DNP, CRNA Peter Kallio, CRNA, DNP (Advisor)
Abstract
Emergence Delirium (ED) following general anesthesia is a common experience across all surgical populations. Multiple studies confirm that a diagnosis of post-traumatic stress disorder (PTSD) increases the risk of experiencing post-anesthetic delirium. Current literature supports the dose dependent use of several anesthetic adjuncts including dexmedetomidine, propofol, and ketamine to reduce the incidence of ED. However, there is conflicting evidence regarding the efficacy and superiority of one agent over another, and there is a lack of established treatment guidelines. Due to the paucity of research focused on this subset population, a scoping review was conducted to synthesize evidence related to ED in patients with known PTSD. A systematic search of three databases resulted in the inclusion of 10 randomized controlled trials (RCT) and two meta-analyses of RCTs that met inclusion criteria. Data was extracted and organized based on the overall occurrence of ED in those prophylactically treated versus a control group, agent to agent, or a head-to-head comparison of a single agent at varying doses. Pooled samples from the included studies resulted in a total of 7,055 patients who were assessed for ED after prophylactic treatment. Dexmedetomidine (DXM) resulted in the most significant reduction compared to placebo (OR= 6.6, P = 0.002), suggesting a strong association in preventing ED. The overall incidence of ED across all studies resulted in a risk ratio of 2.489, indicating an increased risk of ED in untreated patients. Dexmedetomidine, ketamine, and propofol have shown to be effective adjuvants in reducing ED in patients with PTSD. Therefore, providers should determine the course of treatment by considering the patient's comorbidities and surgical procedure.
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