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2016 ; 10
(2
): 164-72
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Delayed recovery from anesthesia: A postgraduate educational review
#MMPMID27212741
Misal US
; Joshi SA
; Shaikh MM
Anesth Essays Res
2016[May]; 10
(2
): 164-72
PMID27212741
show ga
Delayed awakening from anesthesia remains one of the biggest challenges that
involve an anesthesiologist. With the general use of fast-acting anesthetic
agents, patients usually awaken quickly in the postoperative period. The time to
emerge from anesthesia is affected by patient factors, anesthetic factors,
duration of surgery, and painful stimulation. The principal factors responsible
for delayed awakening following anesthesia are anesthetic agents and medications
used in the perioperative period. Nonpharmacological causes may have a serious
sequel, hence recognizing these organic conditions is important. Certain
underlying metabolic disorders such as hypoglycemia, severe hyperglycemia, and
electrolyte imbalance, especially hypernatremia, hypoxia, hypercapnia, central
anticholinergic syndrome, chronic hypertension, liver disease, hypoalbuminemia,
uremia, and severe hypothyroidism may also be responsible for delayed recovery
following anesthesia. Unexpected delayed emergence after general anesthesia may
also be due to intraoperative cerebral hypoxia, hemorrhage, embolism, or
thrombosis. Accurate diagnosis of the underlying cause is the key for the
institution of appropriate therapy, but primary management is to maintain airway,
breathing, and circulation. This comprehensive review discusses the risk factors,
causes, evaluation and management of delayed recovery based on our clinical
experience, and literature search on the internet, supported by the standard
textbooks of anesthesiology.