Delayed awakening after anaesthesia- A challenge for an anaesthesiologist

Abstract

Delayed awakening from anaesthesia remains one of the biggest challenges that involve anaesthesiologists. Most commonly, delayed awakening is due to drugs effects persistence.¹The time taken to emerge to fully consciousness is affected by patient factors, anaesthetic factors, duration of surgery and painful stimulation. Non pharmacological causes may have serious sequel; thus recognising these organic conditions is important.² Unexpected delayed emergence after the use of general anaesthesia has a plethora of causes.³ The most common cause for delayed awakening following anaesthesia is medications and anaesthetic agents used in the perioperative period. There may be an over dose of medications. Emergence from anaesthesia depends on the tissue uptake of the drug, average concentration used and the duration of exposure. Certain underlying metabolic disorders such as hypoglycaemia, severe hyperglycaemia, electrolyte imbalance especially hyponatremia, hypoxia, hypercapnia, central cholinergic syndrome, chronic hypertension, liver disease, hypoalbuminemia, uraemia and severe hypothyroidism may also be responsible for delayed recovery after anaesthesia. Preoperative medications such as opioids and sedatives and hypothermia can further interfere with postoperative recovery. Intraoperative cerebral hypoxia, haemorrhage, embolism or thrombosis also can manifest as delayed awakening from anaesthesia. The ultimate goal of treatment is to find the cause and treat the cause, but primary management is to maintain airway, breathing and circulation.