Project Eagle: Perioperative guidelines to reduce emergence agitation in Veterans with post-traumatic stress disorder

Abstract: Introduction: Posttraumatic Stress Disorder (PTSD) increases veteran risks for emergence agitation. The St. Louis VA adopted “Project Eagle'' in 2022 to reduce the risk of emergence agitation. Research demonstrates >70% of interventions in a multimodal perioperative guideline must be used for maximum efficacy. The purpose of this project was to evaluate CRNA acceptance of the new PTSD guidelines and to improve patient outcomes with education. Methods: A survey questionnaire was developed to assess CRNA experience with PTSD patients as well as their knowledge, acceptance, execution, and satisfaction with Project Eagle. Questionnaire analysis revealed current acceptance and barriers to guideline implementation. Educational resources were developed to address any barriers to practice and promote the utilization of Project Eagle. A second survey was distributed 4 weeks later to reassess. Results: Twelve CRNAs completed the initial questionnaire. Only one CRNA reported using >70% of guideline interventions. Barriers to utilization included anesthesiologist medical direction, lack of participation from the perioperative team, medication availability, and patient comorbidities. Three CRNAs cited knowledge as a barrier. Seven CRNAs attended the in-person education and handouts were provided to all CRNAs. Eleven CRNAs completed the post-intervention questionnaire. Barriers to guideline utilization included increased work, time, and medical direction. Post-intervention surveys showed only one CRNA cited knowledge as a barrier. Three CRNAs stated they used >70% of guidelines. CRNAs felt they received adequate training, were comfortable utilizing the guidelines, saw value in the guidelines, and felt they were easy to use. Conclusion: Most of the CRNAs reported a low incidence of emergence agitation during their career and may not have seen a need for guidelines. However, there was no correlation between emergence agitation experience and the percentage of guideline utilization.