Extended Emergence Strategy for Emergence Delirium

(PACU-EMERGE Trial)

This trial aims to determine if a longer wake-up time from anesthesia after foot or lower-leg surgery can improve recovery. Specifically, the researchers want to see if the Extended Emergence Strategy helps patients think more clearly, reduces pain and the need for pain medication, and allows earlier discharge from the recovery room. Participants will be divided into two groups: one will experience the extended wake-up process, while the other will receive usual care. Eligible participants include those scheduled for foot or ankle surgery with anesthesia and a nerve block, who can complete cognitive tests post-surgery. As an unphased trial, this study offers participants the chance to contribute to innovative research that could enhance post-surgical recovery for future patients.

The trial does not specify if you need to stop taking your current medications, but you cannot participate if you are on chronic opioid therapy, chronic benzodiazepine use, or strongly anticholinergic medications within 30 days before surgery.

Research has shown that a new method for waking up from anesthesia is under study to improve post-surgery recovery. While specific safety details about this method remain limited, it involves altering the wake-up process after anesthesia, which is generally safe. Anesthesia practices undergo careful regulation and close monitoring to ensure safety.

Researchers are excited about the Extended Emergence Strategy for emergence delirium because it introduces a novel method of managing anesthesia emergence using an extended EEG trajectory. Unlike the standard of care, which follows routine EEG monitoring during foot and ankle surgery, this strategy maintains a higher Patient Status Index (PSI) for a minimum of five minutes at the end of the operation. This approach could potentially lead to a smoother awakening process, reducing the risk of delirium in patients. By targeting the emergence phase of anesthesia with precision, this method aims to improve patient outcomes and enhance recovery experiences.

Research has shown that emergence delirium, a state of confusion after waking from anesthesia, can lead to longer recovery times and more complications. Specifically, studies found that patients with this delirium stayed in the recovery room longer and experienced more issues within 30 days post-surgery. The trial tests the Extended Emergence Strategy to improve these outcomes by carefully managing the wake-up process from anesthesia. This approach may help patients think more clearly, feel less pain, and spend less time in the recovery room. Early findings suggest this method can effectively and manageably address emergence delirium.¹²³⁶⁷