Risk factors of delayed recovery from general anesthesia in patients undergoing radical biliary surgery

Zhang, Guohui; Pan, Bingbing; Tan, Dan; Ling, Yingzi

doi:10.1097/md.0000000000026773

Cited by 4 publications

(2 citation statements)

References 45 publications

(65 reference statements)

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“…The main factors responsible for delayed awakening following anesthesia were longer duration of surgery, anesthesia, and high-dose anesthetic medications used during the operative period. [ 10 , 11 ] Despite with the widespread use of rapid acting anesthetic agents, patients often awaken quickly after surgery. Certain underlying organ dysfunction and metabolic disorders may also cause delayed awakening following anesthesia, such as old age, liver disease, renal disease, hypoalbuminemia, electrolyte imbalance, hyper/hypo-glycemia, and hypoxia.…”

Section: Discussionmentioning

confidence: 99%

Delayed discharge from post-anesthesia care unit: A 20-case retrospective series

Liu,

Zhang,

Cai

et al. 2023

Medicine

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Objective: To summarize the characteristics of patients with delayed discharge from the post-anesthesia care unit and to analyze the factors and outcomes of delayed discharge. Methods: Twenty cases of delayed discharge from the PACU (PACU stay >2 hours after surgery) of the main operating room in Liaocheng People’s Hospital, a class A tertiary comprehensive hospital, between January 1, 2021, and December 31, 2022, among 28,084 patients who were transferred to the PACU from the operating rooms after surgery, were retrospectively analyzed. The collected data included patient characteristics, American society of anesthesiologists grade, information related to surgery and anesthesia, and outcomes. The factors for delay were assigned to 1 of 6 groups: delayed recovery from anesthesia, surgical complications, cardiovascular instability, hypoxia, inadequate analgesia, and waiting for the operating room. Results: The incidence of delayed discharge from PACU was 0.7‰. Among 20 patients, more than half of the patients were over 65 years of age, American society of anesthesiologists grade II~III, body mass index <30 kg/m2, and urological surgery (7, 35%), liver surgery (4, 20%), thoracic surgery (4, 20%) accounted for a relatively high proportion. Nineteen (95%) patients received general anesthesia with or without peripheral nerve block. The main factors included delayed recovery from anesthesia (6, 30%), surgical complications (5, 25%), cardiovascular complications (4, 20%), hypoxia (3,15%). After discharge from the PACU, 1 (5%) died in the intensive care unit, and the other 19 (95%) patients were safely discharged from the hospital. Conclusion: The incidence of delayed discharge from the PACU was low, and it was more likely to occur in the elderly, during major operations, and under general anesthesia. Delayed recovery from anesthesia was the most common factor. Most patients were safely discharged from the hospital.

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Section: Discussionmentioning

confidence: 99%

Delayed discharge from post-anesthesia care unit: A 20-case retrospective series

Liu,

Zhang,

Cai

et al. 2023

Medicine

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“…Any complications including hypotension (20% drop in mean arterial pressure from its nadir value for five minutes [15] ), bradycardia (heart rate < 60 bpm at two readings five minutes apart [15] ), vomiting, and delayed recovery (no recovery two hours after surgery, and the patient not correctly responding to verbal commands or other external stimuli [16] ) were recorded.…”

Section: Figure (2)mentioning

confidence: 99%

Dexmedetomidine plus Bupivacaine versus Bupivacaine Alone in Pararectus and Intercostal Blocks in Abdominoplasty: A Randomized Comparative Study

Ghareeb¹,

Askar²,

Ghanem³

et al. 2022

The Egyptian Journal of Hospital Medicine

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Background: Dexmedetomidine is known for its efficacy as a local anesthetic adjuvant. Herein, we studied the beneficial impact of adding dexmedetomidine to bupivacaine in combined intercostal and pararectus block in patients scheduled for abdominoplasty. Patients and methods: This prospective research enrolled 66 patients allocated into two groups; Group I included 33 patients who received combined intercostal and pararectus blocks using bupivacaine plus dexmedetomidine, and Group II included the remaining participants who received the same blocks using bupivacaine alone. Results: All preoperative patient demographic and clinical criteria expressed no significant difference between the two groups. Group I showed a significant decline in opioid requirements throughout the first postoperative day. The time to the first analgesic request showed a significant delay in Group I (14.73 vs 7.39 hours in Group II). Pain scores showed a significant decline in Group I during rest, cough, and movement, compared to Group II. O2 saturation, heart rate, and mean arterial pressure showed no significant difference between the two studied groups. Adding dexmedetomidine was not associated with a significant rise in the incidence of postoperative complications. Conclusion:The addition of dexmedetomidine to the local anesthetic agent during intercostal and pararectal blocks is associated with a better analgesic profile. It is associated with lower pain scores and lower morphine consumption without increased associated side effects.

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Delayed awakening and its associated factor following general anesthesia service, 2022: a cross-sectional study

Bayable,

Amberbir,

Fetene

2023

Annals of Medicine &Amp; Surgery

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Background: The time to emerge from anesthesia is affected by patient factors, anesthetic factors, the duration of surgery, and preoperative and intraoperative pain management. Objective: This study aimed to determine the prevalence and contributing factors of delayed awakening following general anesthesia. Method: A cross-sectional study was conducted from January to June 2022. After getting ethical approval with the permission number S/C/R 37/01/2022, willing patients participate with written informed consent. Chart reviews in the preoperative and postoperative recovery rooms were used to collect data. Frequency and percentage with cross-tabulation were used to provide the descriptive statistics. To determine the predictive variables that were associated with the outcome variable, bivariable, and multivariable logistic regression models were fitted. The statistical significance was evaluated using P-values of 0.05 for multivariable regression. Results: In the current study, a normal emergency occurred in 91.7% of surgical patients receiving general anesthesia, while delayed awakening, emergence with hypoactive, and emergence with delirium occurred in 2.6, 3.9, and 1.8% of cases, respectively. Patients older than 64 years [adjusted odds ratio (AOR): 1.33, 95% CI: 0.83–7.191], being diploma anesthesia providers (AOR: 2.38, 95% CI: 2.05–7.15), opioids (AOR: 2.3, 95% CI: 2.20–5.76), surgery lasting longer than 2 h (AOR: 1.91, 95% CI: 1.83–6.14), estimated blood loss of more than 1500 ml (AOR: 1.20, 95% CI: 0.62–11.30), crystalloid administration of more than 3000 ml (AOR: 3.12, 95% CI: 2.19–7.32), intraoperative hypotension (AOR: 3.37, 95% CI: 2.93–9.41) and extreme body weight, were significantly linked to delayed awakening after general anesthesia. Conclusion: Although delayed emergence is an uncommon condition with a number of contributing causes, it is preventable, and once it has occurred, it presents a challenge for anesthetists.

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Risk factors of delayed recovery from general anesthesia in patients undergoing radical biliary surgery

Cited by 4 publications

References 45 publications

Delayed discharge from post-anesthesia care unit: A 20-case retrospective series

Delayed discharge from post-anesthesia care unit: A 20-case retrospective series

Dexmedetomidine plus Bupivacaine versus Bupivacaine Alone in Pararectus and Intercostal Blocks in Abdominoplasty: A Randomized Comparative Study

Delayed awakening and its associated factor following general anesthesia service, 2022: a cross-sectional study

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