A cross-sectional survey on the clinical management of emergence delirium in adults: knowledge, attitude, and practice in mainland China

Background: Emergence delirium (ED) occurs immediately after emergence from general anesthesia and is defined by restlessness, confusion, and combative or violent actions, which may cause several adverse consequences. To decrease its incidence, the anesthesia-related staff including anesthesiologists and anesthesia nurses are both essential for the early identification and intervention of ED in potential risky patients. However, the current management status for ED among Chinese anesthesiologists and anesthesia nurses is unknown. This cross-section survey aimed to assess Chinese physicians’ and nurses’ knowledge of, attitude and practice towards ED in adults. Methods: : Electronic questionnaires were sent to 93 major academic hospitals across mainland China. One attending anesthesiologist and one anesthesia head nurse were recommended to complete the questionnaire. Results: : 81 anesthesiologists and 71 anesthesia nurses participated in the survey. Most of the participants considered it as a very important issue and over 80% emphasized the essential role of anesthesia nurses during its management. However, less than 1/3 of participants routinely assessed ED. Specifically, anesthesiologists assessed patients only when presenting with delirium symptoms (46.9% of anesthesiologists vs. 26.8% anesthesia nurses, P =0.01), while anesthesia nurses did in all patients (25.4% of anesthesia nurses 8 vs .6% of anesthesiologists, P =0.006). Most participants preferred to diagnose ED based on symptoms. In terms of screening tools, anesthesiologists preferred Confusion Assessment Method, while anesthesia nurses reported multiple screening tools. Divergence also appeared in terms of monitoring the depth of anesthesia. Although the bispectral index was the most common monitoring tool, anesthesiologists monitored only in high-risk patients (60.5% of anesthesiologists vs. 36.6% anesthesia nurses, P =0.003), while the nurses did in all patients routinely (50.7% anesthesia nurses vs 29.6% of anesthesiologists, P =0.008). No unified treatment strategy nor medication was reported for ED treatment during the recovery period. Conclusions: : This study illustrated that there are high awareness levels in both Chinese anesthesiologists and anesthesia nurses regarding the importance of ED. However, the specific practice in terms of routine delirium assessment, anesthesia depth monitoring, and a standardized treatment algorithm need to be implemented to improve ED management. Trial registration: not applicable.