Elective elderly patients undergoing thoracoabdominal surgery in the post- anesthesia care unit are at risk for inadequate emergence, (hypoactive emergence and emergence with delirium). A Cross-Sectional study

Abstract

Abstract Background: - This study aimed to ascertain the prevalence and contributing variables of unsatisfactory emergence after general anesthetic service for elderly patients undergoing thoracoabdominal operations. Method : - In 2022, a cross-sectional study was carried out between December and June. All consenting patients participate with written informed consent after receiving ethical approval. Data has been collected through personally conducting interviews and chart reviews during the pre- and post-operative periods. The descriptive statistics were determined using cross-tabulation or frequency and percentage. Bi-variable and multivariable logistic regression models were fitted to identify predictive variables that were linked to the outcome variable. For multivariable regression, P-values of 0.05 were used to assess statistical significance. RESULTS; - According to the current study, 90.5% (87.4-93.3) of surgical patients under general anesthesia experienced a normal emergence; in contrast, 5.70 %( 3.6-8.2) and 3.90 %( 2.1-5.9) of instances experienced an emergence with delirium and hypoactivity, respectively. A greater risk for emerging delirium was independently linked to anxiety, smoking, substance misuse, anemia, surgical history within three months, hypertension, metoclopramide prophylaxis, thiopentone, and pain ≥4 upon PACU admission,whereas male sex and patients who had ketofol induction were linked to a decreased chance of inadequate emergence. In elderly patients undergoing elective thoracoabdominal surgery, hypothermia in PACU, ASA III, exercise tolerance test (MET<4), and halothane, were found to be independently linked to hypoactive emergence, whereas pethidine, fluid intake ≥2000 ml, blood loss ≥500 ml, surgical duration >2 hrs, and PONV requiring antiemetic were significant risk factors for inadequate emergence. CONCLUSION: - Despite the fact that risk factors are preventable, inadequate emergence is a common complication in elderly thoraco-abdominal surgery that presents challenges for anesthetists and PACU staff. Among elderly patients having thoraco-abdominal surgery, hypoactive emergence was less frequent than emergence delirium.