Perioperative Delirium/Agitation Associated With the Use of Anesthetics and/or Adjunct Agents: A Study of Patient Behaviors, Injuries, and Interventions to Mitigate Risk


  • Matthew A. Taylor, PhD Patient Safety Authority
  • William Pileggi, CRNA, MSN, MAJ, USAR/AN (Ret.) VA Pittsburgh Healthcare System



general anesthesia, monitored anesthesia care, MAC, strategies, solutions, emergence delirium, emergence agitation, preoperative, intraoperative, postoperative, occupational safety


Visual abstract Perioperative Delirium/Agitation Associated With the Use of Anesthetics and/or Adjunct Agents: A Study of Patient Behaviors, Injuries, and Interventions to Mitigate Risk

Anesthetics and adjunct agents have a long history of being associated with patients engaging in delirious or agitated behavior in a perioperative setting. Prior to this study, few have explored the topic with a focus on safety for both the patient and staff. We explored the Pennsylvania Patient Safety Reporting System (PA-PSRS) database for event reports to identify bouts of delirium/agitation associated with anesthetics and/or adjunct agents that occurred during the pre-, intra-, or postoperative period. We identified 97 event reports from 63 healthcare facilities over a two-year period. Patients’ ages ranged from 1 to 91 years and 66% of the patients were reported as male. Also, 8% of the delirium/agitation occurred preoperatively, 8% intraoperatively, and 84% postoperatively. Across all three operative periods, 62% of the reports described dangerous/nonviolent behavior and 26% described dangerous/violent behavior. Additionally, 40% of the event reports described one or more patient injuries (e.g., cardiopulmonary arrest, asphyxiation, hematoma, prolapse/dehiscence, progressive ischemia) and 36% of the patients required additional healthcare services or monitoring (e.g., intra- or interfacility transfer, additional surgical procedure). Finally, 54% of the event reports described patient behavior that created an immediate and high risk of staff harm. Overall, the current study provides novel insight into how delirium/agitation has varying safety implications depending on the operative period. We encourage readers to review Table 5, which proposes a four-phase intervention package to prevent, treat, and de-escalate bouts of delirium/agitation.

Correction: This article was corrected on December 13, 2021, to fix an incorrect percentage in the Discussion section referencing Figure 3.

Author Biographies

Matthew A. Taylor, PhD, Patient Safety Authority

Matthew A. Taylor ( is a patient safety analyst for the Patient Safety Authority (PSA), where he conducts research; uses data to identify patient safety concerns and trends; and develops solutions to prevent recurrence, as well as tools and materials to help facilities and clinicians improve patient safety. Prior to joining the PSA, Taylor was a scientific writer and research specialist at the University of Pittsburgh School of Pharmacy, and he has served fellowships at the Centers for Disease Control and Prevention (CDC) and the VA Pittsburgh Healthcare System. His expertise in data analysis and research covers a range of topics, including patient safety, public health, employee training, process efficiency, human factors, workplace culture/climate, behavior change interventions, and organizational management.

William Pileggi, CRNA, MSN, MAJ, USAR/AN (Ret.), VA Pittsburgh Healthcare System

William Pileggi is a certified registered nurse anesthetist for the VA Pittsburgh Healthcare System’s (VAPHS) Department of Anesthesiology. He is the lead anesthesia team instructor for VAPHS’s PTSD/Emergence Delirium Safety Training and Response Team, collaborating with physician anesthesiologists in anesthesia care and delivery. In this role, he teaches perioperative staff how to better identify and assess those veterans most at risk for emergence delirium and co-instructs anesthesia personnel on medication choice and strategy to prevent and/or treat emergence delirium. Pileggi has worked in healthcare since joining the Army in 1984. He is a 26-year Army Reserve retiree, major, Nurse Corps officer, which includes five years as an enlisted operating room technician (sergeant). Pileggi also had 20 years of practice at the University of Pittsburgh Medical Center.


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Silhouette of a doctor with a mask on looking down, with an OR light hanging above in the background.

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How to Cite

Taylor, M. A., & Pileggi, W. (2021). Perioperative Delirium/Agitation Associated With the Use of Anesthetics and/or Adjunct Agents: A Study of Patient Behaviors, Injuries, and Interventions to Mitigate Risk. Patient Safety, 3(4), 16–27.



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