UPDATES ON MANAGEMENT OF DELAYED EMERGENCE FROM ANESTHESIA

Abstract

Delayed emergence after anesthesia is still a challenging problem facing anesthesiologists because of multiple factors can cause the delay either in patients, drugs used, technique used (which is the art of anesthesia). Causes can be divided into common and uncommon causes. Common causes subdivided into pharmacological due agents used residuals either over dosage or not eliminated due to patient factor (hepatic or renal disease); or metabolic which include electrolytes imbalance, hypo\hyperglycemia, hypothyroidism; or respiratory due to previous disease or acute lung injury; or neurological due to prolonged hypoxia or undiagnosed congenital anomalies or events such as hemorrhage, embolism and thrombosis. Uncommon causes include: Drug interaction, Serotonin syndrome, Emergence delirium, Central anticholinergic syndrome, Psychiatric disorders, Perioperative cardiac complications, Drug abuse, Unintentional mistakes, Regional anesthesia complication and Perioperative intracranial hemorrhage as a surgical complication. Whatever the cause management primarily must focus on securing the airway, ensure adequate breathing and stabling the hemodynamics. Then proper investigation to reach to the cause, with considering rare causes and unexpected erroneous usage of drugs, should take second place.