Role of amino acid infusion in delayed recovery from neuromuscular blockers

Delayed awakening from anesthesia remains one of the biggest challenges that involve an anesthesiologist. With the general use of fast-acting anesthetic agents, patients usually awaken quickly in the postoperative period. The time to emerge from anesthesia is affected by patient factors, anesthetic factors, duration of surgery, and painful stimulation. The principal factors responsible for delayed awakening following anesthesia are anesthetic agents and medications used in the perioperative period. Nonpharmacological causes may have a serious sequel, hence recognizing these organic conditions is important. Certain underlying metabolic disorders such as hypoglycemia, severe hyperglycemia, and electrolyte imbalance, especially hypernatremia, hypoxia, hypercapnia, central anticholinergic syndrome, chronic hypertension, liver disease, hypoalbuminemia, uremia, and severe hypothyroidism may also be responsible for delayed recovery following anesthesia. Unexpected delayed emergence after general anesthesia may also be due to intraoperative cerebral hypoxia, hemorrhage, embolism, or thrombosis. Accurate diagnosis of the underlying cause is the key for the institution of appropriate therapy, but primary management is to maintain airway, breathing, and circulation. This comprehensive review discusses the risk factors, causes, evaluation and management of delayed recovery based on our clinical experience, and literature search on the internet, supported by the standard textbooks of anesthesiology.

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“…We, the anesthesiologists, make the patient sleep, so the recovery from anesthesia is our responsibility. 59 …”

Section: Discussionmentioning

confidence: 99%

Delayed recovery from anesthesia: A postgraduate educational review

2016

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“…I read with interest the recent case report by Kalra. [ 1 ] titled “Role of amino acid infusion in delayed recovery from neuromuscular blockers”. I admit that it was difficult to establish a differential diagnosis in this case regarding the cause of excessive sedation and unresponsiveness seen in the post operative period.…”

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confidence: 99%

Temperature monitoring: An often neglected but essential standard monitor

Malik¹

2011

Indian J Anaesth

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“…I appreciate the successful management of a patient with recurarisation[ 1 ] due to suspected hypothermia. But we have some concerns regarding the author’s findings and the related interpretation.…”

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confidence: 99%