Anaesthetic emergence agitation in adults following general surgery: A scoping review

Background: Anaesthetic emergence is the patient's transition from general anaesthetic until they are alert and in full control of vital reflexes. It is during this transition that significant complications, including anaesthetic emergence agitation, may occur. A preliminary search did not identify any research investigating adults who undergo anaesthetic emergence in critical care settings.

Objectives: To map the post-anaesthetic literature reporting outcomes, risk factors, and management of adult patients admitted directly to a critical care unit, who develop emergence agitation, and to describe the implications for clinical practice.

Methods: The scoping review was registered at https://osf.io/spwx5/ and conducted using the Joanna Briggs Institute methodology, with the framework of Population, Concept and Context. Search terms including agitation, anaesthetic, emergence, postoperative and surgery.

Results: Twenty-five articles were identified and were eligible for data extraction. Risk factors included co-morbid conditions, anaesthetic agents and the presence of in-situ invasive devices. Studies varied regarding design and patient assessment tools. Data were reported from one or more of eight observation timepoints along the emergence continuum, from end-anaesthetic until post anaesthetic care unit discharge. No studies investigated patients with direct postoperative admission to critical care settings.

Conclusions: This review has characterised the emergence continuum. The variations between studies has highlighted the necessity to reach future consensus regarding emergence definition and measurement. A critical gap was identified regarding recommendations for prevention and management of emergence agitation for patients admitted directly to a critical care unit.