Dexmedetomidine for the Prevention of Emergence Agitation in Adult Surgical Patients

Abstract

Purpose: This quality improvement initiative aimed to evaluate the impact of education on increasing healthcare providers’ knowledge of dexmedetomidine for preventing emergence agitation (EA) in adult surgical patients.Background: Emergence agitation and delirium are temporary post-anesthesia states that can result in confusion, violent outbursts, and potential harm to both patients and healthcare staff (Tolly et al., 2020). These terms are often used interchangeably and describe linked concepts (Lee & Sung, 2020). EA can compromise patient safety and contribute to sentinel events in the post-anesthesia care unit (PACU) (Zhang et al., 2019). Dexmedetomidine, a selective α₂-adrenergic receptor agonist, provides sedative, analgesic, anxiolytic, and sympatholytic properties while minimizing respiratory depression and allowing for a more cooperative emergence (Lee, 2019). Research does suggest that dexmedetomidine does not increase PACU length of stay or cause residual sedation. It does successfully reduces problems such as shivering, coughing, and postoperative nausea and vomiting (Sin et al., 2022). Despite its benefits, dexmedetomidine use for EA prevention remains lacking in consistency, showing the need for improved provider education. Methods: An educational intervention was delivered to healthcare providers, followed by a pre-post survey administered via Qualtrics. The Wilcoxon signed-rank test was used to analyze changes in participants’ knowledge regarding dexmedetomidine’s role in EA prevention. Results: All participants (11/11) completed the survey, with 72.7% attending the session in person and 27.3% accessing the recorded session remotely. Statistically significant improvements were observed across all 10 Likert-scale survey questions, with mean differences indicating increased knowledge, confidence, and readiness to apply the information clinically. The largest knowledge gains were seen in understanding EA’s incidence, risks, and costs (Question 1) and dexmedetomidine’s mechanism of action, side effects, and dosing (Question 2). Free-text responses (Question 11) identified barriers to implementation, including cost, availability, hemodynamic concerns, and knowledge gaps, which provide insight into areas for future education and practice improvements. Conclusions: Results of this project indicated that education notably improves healthcare providers’ knowledge, confidence, and willingness to implement dexmedetomidine for EA prevention. The results also emphasized the importance of continued education and training to reinforce evidence-based practice and improve patient safety in anesthesia care.