Independent Predictors of Delay in Emergence From General Anesthesia

Abstract

Some patients with intellectual disabilities spend longer than others in emergence from ambulatory general anesthesia for dental treatment. Although antiepileptic drugs and anesthetics might be involved, an independent predictor for delay of the emergence remains unclear. Thus, a purpose of this study is to identify independent factors affecting the delay of emergence from general anesthesia. This was a retrospective cohort study in dental patients with intellectual disabilities. Patients in need of sedative premedication were removed from participants. The outcome was time until emergence from general anesthesia. Stepwise multivariate regression analysis was used to extract independent factors affecting the outcome. Antiepileptic drugs and anesthetic parameters were included as predictor variables. The study included 102 cases. Clobazam, clonazepam, and phenobarbital were shown to be independent determinants of emergence time. Parameters relating to anesthetics, patients' backgrounds, and dental treatment were not independent factors. Delay in emergence time in ambulatory general anesthesia is likely to be related to the antiepileptic drugs of benzodiazepine or barbiturates in patients with intellectual disability.

Towards a better understanding of anesthesia emergence mechanisms: Research and clinical implications

“…Thus, in a hypothetical scenario, it could be possible to modulate the path of emergence, choosing the one which correlates with the desired target. The possibility to increase the predictability of the time of emergence may help prevent delayed emergence - defined as the failure to regain consciousness 30-60 min after general anesthesia[ 51 ] - and other more frequent AE complications, such as ED, and respiratory complications. This is a significant issue as delayed emergence was associated with a longer postoperative hospital stay[ 52 ], whereas ED in children may lead to physical harm in the children and distress in patients, parents and staff.…”

Effect of dexmedetomidine combined with sufentanil on preventing emergence agitation in children receiving sevoflurane anesthesia for cleft palate repair surgery

“…Although sevoflurane is associated with a high incidence of EA, it has been widely used as a sole agent for pediatric anesthesia (25). Numerous studies have shown that benzodiazepines, barbiturates and opioids contribute to behavioral disturbances after sevoflurane general anesthesia (26,27).…”

Perioperative management of patients with mental diseases

“…Последнее может приводить к изменениям (усилению) фармакологических эффектов препаратов, применяемых в терапевтических дозировках, усиливая их побочные действия [123]. В частности, показано увеличение интервала QT у пациентов кардиологических ПИТ, принимающих антидепрессанты [125]; усиление седативного эффекта трамадола в послеоперационном периоде [126]. Подобные изменения фармакологических эффектов могут отмечаться у антиаритмических препаратов класса IC, β-адреноблока торов, теофиллина, фенитоина, бензодиазепинов, варфарина [2,87].…”