Emergence Delirium in Adult Surgical Patients in Post Anaesthesia Care Unit at Kenyatta National Hospital, a Descriptive Observational Study

Abstract

Emergence delirium is a transient condition characterized by an alteration in awareness and inattention to one’s immediate environment with disorientation and perceptual alterations like hypersensitivity and hyperactive motor behavior immediately post recovery from anaesthesia. During this time the patient is confused, agitated or disinhibited. They can be hyperactive or hypoactive. Hyperexitability presents with crying, non-purposeful movements or hallucinations during emergence from anaesthesia. Hypoactive present with a withdrawn state with difficulty in arousal. It poses a danger to patients, staff and also results in an increase in the utilization of resources. Studies done on emergence delirium have been done on paedriatic population who encompass only a small percentage of patients attended to in KNH. The incidence was 43.7% There are no guidelines for the management of emergence delirium in KNH currently. We need to know the incidence of emergence delirium to guide the formulation of guidelines for the same. A number of scales have been used to study to study delirium. Scales used include: Confusion Assessment Method for ICU( CAM-ICU),Riker Sedation Agitation scale (SAS), Richmond Agitation Sedation scale (RASS), Motor activity assessment scale,3-min Diagnostic Confusion Assessment Method( 3D-CAM)New Sheffield sedation scale, Nursing Delirium Screening Scale, Confusion Assessment Method. The study used both the CAM-ICU and the RASS scales. CAM-ICU was used to detect the presence of delirium while the RASS was used to classify the delirium into hyperactive and hypoactive. Incidence of delirium was found to be 64.5% with hyperactive delirium at 30.9% and hypoactive was 33.6%.Risk factors for development of delirium were advanced age( >69 years), ASA 1, ENT surgery, surgery lasting 61-120 minutes and those above 360 minutes and use of Cannabis sativa. Pain and anxiety were the most reported cause of hyperactive delirium while hypoactive was as a result of inadequate emergence. Objectives: General Objective Was to determine the incidence of emergence delirium in adult patients undergoing surgery at Kenyatta National Hospital.