<p>Delayed Emergence from Anesthesia: What We Know and How We Act</p>

Abstract

The emergence from anesthesia is the stage of general anesthesia featuring the patient’s progression from the unconsciousness status to wakefulness and restoration of consciousness. This complex process has precise neurobiology which differs from that of induction. Despite the medications commonly used in anesthesia allow recovery in a few minutes, a delay in waking up from anesthesia, called delayed emergence, may occur. This phenomenon is associated with delays in the operating room, and an overall increase in costs. Together with the emergence delirium, the phenomenon represents a manifestation of inadequate emergence. Nevertheless, in delayed emergence, the transition from unconsciousness to complete wakefulness usually occurs along a normal trajectory, although slowed down. On the other hand, this awakening trajectory could proceed abnormally, possibly culminating in the manifestation of emergence delirium. Clinically, delayed emergence often represents a challenge for clinicians who must make an accurate diagnosis of the underlying cause to quickly establish appropriate therapy. This paper aimed at presenting an update on the phenomenon, analyzing its causes. Diagnostic and therapeutic strategies are addressed. Finally, therapeutic perspectives on the “active awakening” are reported.

Opioid-Free Naloxone Emergence Under Dexmedetomidine: A Case Report

“…The most common causes of delayed emergence are residual anesthetic agents, drug interactions, polypharmacy, surgical complications, neurologic sequelae, endocrine/metabolic derangement, and psychiatric conditions. Some other uncommon reasons include pseudocholinesterase deficiency, serotonin syndrome, central anticholinergic syndrome, and narcolepsy/sleep paralysis [16]. In this case the patient's vital signs, body temperature, ABG results, glucose level, and ETCO₂ were within normal limits.…”

The use of sugammadex in an infant with prolonged neuromuscular blockade - A case report -

“…Therefore, other causes had to be identified initially before determining that the cause of delayed recovery was due to RNMB. Delayed recovery from anesthesia has a variety of causes, including pharmacokinetics, pharmacodynamics, and neurological reasons [ 12 ]. Firstly, cerebral ischemia was considered, the most likely neurological reason.…”

Identifying c-fos Expression as a Strategy to Investigate the Actions of General Anesthetics on the Central Nervous System

“…Rapid recovery from unconsciousness is the most important characteristic of general anesthesia compared to other disruptions of consciousness, such as coma. Inadequate emergence, including emergence delirium and delayed emergence, may occur despite a stable state during surgery and general anesthesia [ 89 ], which can lead to delays in the operating room, the overall increase in costs, coughing, potential intracranial or intraocular pressure rise, respiratory accidents, and hemodynamic instability [ 89 ]. Up to 20% of general anesthesia awareness with recall episodes is attributed to the awakening phase [ 90 ].…”