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Introduction: Ten percent of adults will experience post-traumatic stress disorder (PTSD) at some point during their lifetime, 50% of which remain untreated and undiagnosed. Perioperative management of the patient with PTSD may create significant challenges for the anesthesia provider. Patients with PTSD are more likely to experience emergence delirium (ED), which poses a significant safety threat to patients and staff. Screening for PTSD is routine in the veteran population but has not yet translated into common practice. To our knowledge, no protocol currently exists for anesthetic management of patients with PTSD. Routine screening for PTSD in the preoperative period and utilization of an evidence based anesthetic protocol for this subset of patients may help prevent ED and the associated safety risks.

Methods: Literature review was conducted to search for best practices regarding anesthetic management of patients with PTSD. Database searches included Cochrane Library, CINAHL, Medline, PubMed, HAPI, Trip, Google Scholar, Proquest Dissertations and Theses Global, Psychiatry online, Psychinfo, and Summon. Eighteen studies met inclusion criteria. Directed content analysis was developed from the search, and potential components of protocol were electronically sent to a panel of expert reviewers consisting of anesthesiologists and Certified Registered Nurse Anesthetists (CRNA) in the form of a 4-point rating scale. A comment box was also available for qualitative feedback. A perioperative anesthetic protocol for patients with PTSD was developed based on directed content analysis.

Sample & Setting: Survey was sent electronically via e-mail to 31 anesthesia providers from three different hospital systems affiliated with FJTSA. Fourteen anesthesia providers completed the survey.

Results: Content validity index was performed for each item in the survey. Content validity index (I-CVI) greater than 0.78 was desirable for each item. Four out of eleven items had I-CVIs greater than 0.78.

Conclusion: Content validity scores for protocol items were undesirable despite strong existing literature that certain anesthetic techniques either contribute to ED or help prevent it. This indicates a very evident knowledge deficit regarding current best practices for perioperative management of patients with PTSD or possible PTSD. This knowledge gap suggests that anesthesia providers would benefit from an evidence-based protocol to help guide anesthetic management of patients with PTSD. Keywords: emergence delirium, PTSD, anesthesia, protocol