Psychogenic Coma After Use of General Anesthesia for Ethmoidectomy

Abstract

Failure of a patient to awaken promptly after use of general anesthesia may be due to various causes, including medication-related effects, neurologic insults, or metabolic disturbances. Herein we describe a 49-year-old woman with a history of depression, for which she was receiving treatment, who did not awaken promptly after use of general anesthesia for ethmoidectomy. Results of neurologic examinations were normal, as were laboratory tests and radiologic studies. Six hours after completion of the operation, the patient spontaneously awakened. We hypothesize that she underwent a transient, self-limited period of dissociation related to unresolved grief due to the recent death of a family member.

Repeated episodes of difficulty with arousal following general anesthesia in a patient with ulnar neuropathy

“…Regardless, delayed emergence in a patient who previously experienced "functional" delayed awakening should alert the anesthesiologist to the possibility of a psychiatric cause. Indeed, in the majority of previously reported cases, the patient had a signifi cant psychiatric history, including primary psychiatric disorders (depression, bipolar disorder, posttraumatic stress disorder, anxiety, or substance abuse history) [4,[6][7][8]11,14] and/or personality disorder (borderline and histrionic personality traits) [3,4]. Our patient had undergone preoperative psychiatric evaluation which did not reveal either a psychiatric or a personality disorder.…”

“…Psychogenic coma following general anesthesia is rare [3,4,[6][7][8][10][11][12][13][14][15]. Most previous cases involved female patients undergoing otolaryngologic or gynecologic procedures.…”

“…Because psychogenic coma is a diagnosis of exclusion, patients undergo an extensive work-up to identify potentially lifethreatening conditions. These patients usually have an underlying psychiatric or psychological condition, personality disorder, or external incentive for symptom fabrication [3,4,[6][7][8]10,11]. We report a unique case of a woman with no history of psychiatric disorders or were dilated, responsive to light, and 7 mm in diameter.…”

“…However, there are rare situations in which delayed emergence from anesthesia may be the result of psychogenic factors ("psychogenic coma"); namely, factitious, conversion, and dissociative disorders [3][4][5][6][7][8][9]. Because psychogenic coma is a diagnosis of exclusion, patients undergo an extensive work-up to identify potentially lifethreatening conditions.…”

Recurrent Psychogenic Coma Following Tracheal Stenosis Repair

“…[4][5][6][7][8] None have been reported in the otolaryngologic literature, however. Our patient is unique because she demonstrated repeated episodes of unconsciousness following successful recovery from anesthesia.…”