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Continuing Education in Anaesthesia, Critical Care & Pain 2006 6(3):114-118; doi:10.1093/bjaceaccp/mkl020
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Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 3 2006 © The Board of Management and Trustees of the British Journal of Anaesthesia [2006]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Delayed recovery of consciousness after anaesthesia

Rhona C F Sinclair, B MedSci BM BS MRCP
Senior House Officer, Department of Anaesthesia, Derbyshire Royal Infirmary Derby DE1 2QY, UK

Richard J Faleiro, BSc (Hons) DCH FRCA
Consultant in Anaesthesia and Pain Medicine, Department of Anaesthesia, Derbyshire Royal Infirmary Derby DE1 2QY, UK Tel: 01332 347141 ext. 4747 Fax: 01332 254963 E-mail: richard.faleiro@nhs.net (for correspondence)
The first 150 words of the full text of this article appear below.


Key points

Delayed recovery from anaesthesia is often multifactorial.

Consider drug interactions with neuromuscular blocking agents.

Metabolic abnormalities will not present with the usual signs and symptoms in the anaesthetized patient.

Organic causes of prolonged unconsciousness may have important sequelae that should be managed appropriately.

Rarely, disassociative states may present with episodes of unconsciousness with no other identifiable cause.

 

A conscious individual, as defined in the Oxford English Dictionary, is ‘awake and aware of their surroundings and identity’. However, consciousness represents a continuum with varying depths of consciousness. Coma is derived from the Greek ‘koma’ meaning a state of sleep; more specifically, it is defined medically as ‘a state of unresponsiveness from which the patient cannot be aroused’.

By convention we use the Glasgow coma scale (GCS) to provide a rapid, reproducible quantification of depth of unconsciousness. Although the GCS was developed for assessment and prediction of outcome in traumatic . . . [Full Text of this Article]


   Causes of prolonged unconsciousness after anaesthesia
 
Pharmacological

Benzodiazepines

Opioids

Neuromuscular block

I.V. anaesthetic agents

Volatile anaesthetic agents

Metabolic causes

Hypoglycaemia

Hyperglycaemia

Hyponatraemia

Hypernatraemia

Uraemia

Hypothermia

Respiratory failure

Neurological causes

Uncommon causes

Central anticholinergic syndrome

Disassociative coma


   Clinical assessment
 

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