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.
The use of muscle relaxant for intubation has become an important aspect of modern anaesthesia. Different new nondepolarizing drugs are in use for the same purpose. Aims and Objectives: To compare the effect on intubating conditions and haemodynamic changes using Vecuronium and Rocuronium bromide for laryngoscopy. Methodology: Present randomized controlled study was conducted on 60 patients, between 18 -60 years of age and belonging to ASA grade I & II who were scheduled for various elective surgeries under general anaesthesia. These patients were randomly allocated into two groups of thirty each. All were premedicated and induced with Inj. Fentanyl and Inj. Propofol. After induction tracheal intubation was facilitated by giving either Inj. Rocuronium 0.6 mg/kg or Inj. Vecuronium 0.1 mg/kg to patients of Group A and Group B respectively. Anaesthesia was maintained on N2O (66.6%) and O2 (33.3%) mixture Analgesics, and either Vecuronium or Rocuronium as muscle relaxant with Sevoflurane. Conclusion: There was no difference in intubating conditions and haemodynamic response between Rocuronium and Vecuronium.
during the month of December 2007 after reversal of neuromuscular block with Neostigmine resulting in morbidity. The drug was newly supplied on a rate contract basis to Government hospitals. The incidence was reported to the authorities. Further use of the drug stopped and the sample sent to Food and Drugs Administration department (FDA) for analysis. FDA analyzed the drug and reported that it was of a "Substandard Quality". We are presenting 2 cases of Non-cardiogenic pulmonary edema occurred after the use of this "Substandard Neostigmine".
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