NO SLEEPING BEAUTY: DELAYED EMERGENCE UNDER GENERAL ANESTHESIA AN EMERGENCY CASE AFTER ANESTHESIA Lusy Saputri, Gezy Giwangkancana, Erwin Pradian, Iwan Fuadi, Suwarman, Reza Sudjud
Department of Anesthesiology and Intensive Care Faculty of Medicine Padjajaran University
Abstract
Introduction: Delayed emergence from anesthesia is defined as failure to regain consciousness within 20-30 min after a surgical procedure. The most common causes of delayed emergence are benign and mostly related to residual anesthetic effects. However, some causes are uncommon. Low incidence impedes the design of meaningful clinical trials investigating potential mechanisms and risk factors.
Case Resume: A 9 years old girl came to the hospital for elective mouth preparation. She has Atrial Septal Defect (ASD) but was overall in good physical condition. She was induced by general anesthesia technique and she was intubated and her ventilation was assisted manually using a pediatric bain circuit. Surgery lasted for 40 minutes with stable hemodynamic. Six hours after the end of the surgery, the patient remained apneutic and there was no respond to pain stimulation. Upon consultation a complete blood work was done including blood gas analysis, electrolytes, ureum and bedside blood glucose. An etCO2 was placed and etCO2 was shown at 105 mmHg. The treatment for hypercapnia was given and within 5 minutes ETC02 was normalized to 43. The patient was transferred to the PICU and after 4 hours was awake and extubated. After 8 hours all symptoms was reversed and the patient was released home the 2 days after without any neurological symptomps
Discussion: Delayed recovery from anesthesia is often multifactorial, and anesthetic agents may not always be the causes. Primary management is supportive and meticulous programed approach of causal detection must be followed.
Keywords: delayed emergence, emergency, general anaesthesia, hypercapnia, risk factor
