Postanesthesia emergence in patients with post-traumatic stress disorder.
OBJECTIVE
Recovery from anesthesia may be complicated with development of severe panic symptoms and anxiety. Preexisting anxiety disorder has been reported as a risk factor for development of these symptoms. We aimed to examine the frequency of emergence delirium (EDL) among veterans diagnosed with posttraumatic stress disorders (PTSDs).


METHODS
Retrospective cohort.


METHODS
Postoperative recovery area.


METHODS
Perioperative information of 1763 consecutive patients who underwent a surgical procedure requiring general anesthesia were collected. The patients were grouped on the basis of previous diagnosis of PTSD. A total of 317 patients were identified with a positive history of PTSD and were compared to 1446 patients without such a history for the occurrence of EDL in the postanesthesia care unit (PACU) as the primary endpoint.


METHODS
Duration of stay in PACU in minutes and the frequency of hospital admission were the secondary endpoints. Multivariate binary logistic regression analysis was performed to identify the predictors of EDL among the veteran population.


RESULTS
Emergence delirium was reported in 37 cases (2.1%) after general anesthesia. Fifteen (4.7%) of 317 patients with PTSD and 22 (1.5%) of 1446 patients without history of PTSD demonstrated symptoms related to EDL in the PACU (P=.002). After propensity matching, there were 8 patients with EDL in the PTSD group whereas there were only 2 patients with EDL among controls. Posttraumatic stress disorder was also an independent predictor of EDL in multivariate analysis with an odds ratio of 6.66 and a 95% confidence interval of 2.04 to 21.72 (P=.002).


CONCLUSIONS
Posttraumatic stress disorder independently predicted the frequency of EDL even after correcting for preexisting depression and anxiety disorders. A relatively longer duration of PACU stay in PTSD patients may reflect raised awareness of the health care workers about this debilitating mental disorder.
Department of Anesthesiology, University at Buffalo, Buffalo, NY, 14214. Electronic address: umholtz129@gmail.com.
Matthew
M
Umholtz
Department of Anesthesiology, Sisters of Charity Catholic Health System, Buffalo, NY, 14215. Electronic address: jcilnyk@gmail.com.
John
J
Cilnyk
Department of Anesthesiology, University at Buffalo, Buffalo, NY, 14214. Electronic address: kwang4@buffalo.edu.
Christopher K
CK
Wang
Department of Anesthesiology, University at Buffalo, Buffalo, NY, 14214; Anesthesiology Svc, VA Western NY Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215. Electronic address: jahanpor@buffalo.edu.
Jahan
J
Porhomayon
Department of Anesthesiology, University at Buffalo, Buffalo, NY, 14214. Electronic address: leilipou@buffalo.edu.
Leili
L
Pourafkari
Department of Anesthesiology, University at Buffalo, Buffalo, NY, 14214; Anesthesiology Svc, VA Western NY Healthcare System, 3495 Bailey Avenue, Buffalo, NY, 14215. Electronic address: nnader@buffalo.edu.
Nader D
ND
Nader
D000368:Aged; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000009:adverse effects*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects*; D001007:Anxiety / Q000209:etiology; D001008:Anxiety Disorders / Q000150:complications; D003863:Depression / Q000150:complications; D000071257:Emergence Delirium / Q000139:chemically induced / Q000209:etiology*; D005045:Etomidate / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010200:Panic; D012189:Retrospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*; D014728:Veterans
D018686:Anesthetics, Intravenous; D005045:Etomidate
Anesthetics; Emergence delirium; Postanesthesia care unit; Posttraumatic stress disorder