IMMEDIATE POST-ANAESTHESIA CONFUSION AND AGITATION IN ADULT SURGICAL PATIENTS: INCIDENCE AND CLINICAL CORRELATES.

BACKGROUND

Cognitive disturbances during recovery from anaesthesia are clinically important but often underrecognized in adult surgical patients. Immediate confusion or agitation during the emergence phase may represent transient neurocognitive changes related to anaesthetic effects rather than true postoperative delirium. Early identification of these disturbances in the post-anaesthesia care unit (PACU) is essential for patient safety and appropriate postoperative monitoring.

AIM: This study aimed to determine the incidence of immediate post-anaesthesia confusion and agitation at PACU admission and to identify its clinical correlates in adult patients undergoing elective surgery.

METHODS

A prospective observational study was conducted at Thumbay University Hospital, Ajman. Adult patients aged 18-65 years undergoing elective surgery under general anaesthesia (GA) or regional anaesthesia (RA) were enrolled (n=120). Cognitive status was assessed using the Confusion Assessment Method (CAM) and CAM-ICU at PACU admission (0 h) and at 6, 12, 24, 48, and 72 hours postoperatively. Demographic data, ASA physical status, baseline cognitive screening, type of surgery, anaesthetic technique, and physiological variables were recorded. The primary outcome was the incidence of immediate post-anaesthesia confusion or agitation at PACU admission.

RESULTS

Immediate post-anaesthesia confusion or agitation was observed in 25% of patients (30/120) at PACU admission. The incidence declined to 5.0% at 6 hours and 0.8% at 12 hours, with no new cases identified after 24 hours. The frequency of immediate confusion was higher among patients receiving general anaesthesia compared with regional anaesthesia (37.3% vs 9.4%). Patients with early confusion demonstrated higher respiratory rates at PACU admission and were more likely to have higher age and lower baseline cognitive screening scores.

CONCLUSION

Immediate post-anaesthesia confusion or agitation occurred in one-quarter of patients but resolved rapidly in most cases. Early cognitive screening in the PACU may help distinguish transient emergence phenomena from clinically significant postoperative neurocognitive disorders.