Improving Understanding of Anesthetic Considerations for Emergence Agitation Prevention and Treatment in Veterans

Abstract

Purpose. The purpose of this Doctor of Nursing Practice project was to implement qualityinterventions aimed at increasing the knowledge, attitudes, and confidence of anesthesia providers in the prevention and treatment of emergence agitation (EA) in veterans. Background. Emergence agitation is defined as a short-lived syndrome that occurs during awakening from general anesthesia. Emergence agitation is prevalent in military veterans due to the independent risk factor of post-traumatic stress disorder. There is an increased potential for agitation, inconsolability, and violent involuntary movement during this period. Sequelae lead to acute patient self-harm, increased mortality and morbidity, staff injury, and increased costs. Methods. Bandura’s Social Learning Theory and the Iowa Model guided the project. Anesthesia providers (n=30) at a medical center in Southern Arizona were recruited via email to attend an in-person education presentation and participate in a pre- and post-survey (6 Likert-scaled questions) on anesthetic considerations for EA. Quantitative data was analyzed with a paired samples t-test using the IBM Statistical Package for the Social Sciences software (Version 29) to determine statistical significance after the educational presentation. Results. There was a 63% (19/30) attendance rate of anesthesia providers from those who sent the recruitment email for the education session and a 95% (18/19) survey response rate of those who attended the presentation. All six questions increased pre- and post-survey responses or positive mean difference (MD = 0.67, SD = 0.33). Despite a positive mean difference for question 5 responses, the paired sample t-test result was not statistically significant due to a p- value > 0.05 and a t (17) value < 2.110 (MD = 0.22, SD = 0.80, t (17) = 1.29, p = 0.22). Conclusions: Evidence-based practice anesthesia considerations can be used for prophylaxis and treatment of emergence agitation. Analysis of collected data from the implementation of an education presentation showed an effect where there was an improvement in general understanding of emergence agitation and the prevention and treatment of its clinically significant sequelae.