Delayed recovery due to exaggerated acid, base and electrolyte imbalance in prolonged laparoscopic repair of diaphragmatic hernia

Garg, Rakesh; Punj, Jyotsna; Pandey, Ravindra Mohan; Darlong, Vanlal

doi:10.4103/1658-354x.76477

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…reported a case of delayed recovery after prolonged laparoscopic repair of diaphragmatic hernia under general anesthesia due to tissue handling and fluid replacement responsible for metabolic acidosis, hyperkalemia, and hypocalcemia. [ 26 ] Recovery may be delayed if soluble volatile agents are continued until the end of surgery or long-acting drugs are given toward the end of the procedure. [ 19 23 ]…”

Section: Risk Factorsmentioning

confidence: 99%

Delayed recovery from anesthesia: A postgraduate educational review

2016

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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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Section: Risk Factorsmentioning

confidence: 99%

Delayed recovery from anesthesia: A postgraduate educational review

2016

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“…These results were contradictory with the study conducted by Reilly et al on anaesthetized tigers in which the plasma calcium showed a significant decrease over the course of anaesthesia [21]. Likewise, Garg et al related hypocalcaemia in a human patient during laparoscopic repair of a diaphragmatic hernia [10]. However, in their report, the iCa imbalance was attributed to fat tissue handling and necrosis, due to calcium binding to adipose tissue.…”

Section: Discussionmentioning

confidence: 84%

Evaluation of blood electrolyte alterations in cats during elec-tive laparoscopic ovariectomy

et al. 2021

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In a clinical setting, we tested the hypothesis of whether hypercapnia developed during carbon dioxide pneumoperitoneum is associated with changes in blood electrolytes. This prospective study involved ten female cats that underwent elective laparoscopic ovariectomy. Venous blood samples for assessment of electrolytes were collected in the following sequence: T1- before anaesthesia induction, T2 - 10 minutes after anaesthesia induction, T3 - 30 minutes of pneumoperitoneum and T4 - at the end of pneumoperitoneum. Statistical analysis revealed AB disturbances associated with general anaesthesia and pneumoperitoneum, manifested with decreased blood pH, whereas blood PvCO2, PO2 and BE were increased. A constant increase of K+ concentration was recorded in all animals during pneumoperitoneum (P<0.05), whereas iMg registered a significant increase only at T3 (P<0.05). Correlations were recorded between blood pH and Na+, iCa, iMg, as well as between Na+ and Cl¯ at different time points during anaesthesia. No correlations were noted between pH and K+ or PvCO2 and K+. In conclusion, electrolyte imbalance represents a possible complication associated with laparoscopic surgery in healthy cats. However, further studies should investigate the causes involved in K+ concentration elevation.

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“…Anesthetic drug administration techniques responsible for the duration of awareness after anesthesia (27) . A study by Garg et al revealed that delayed recovery after long time laparoscopic procedure for hernia repair by general anesthesia occurs (28) . Also, repeated administration of anesthetic agents for long term surgery is another cause for delayed recovery (29) .…”

Section: Duration Of Anesthetic Usedmentioning

confidence: 99%

Factors Related to Delayed Recovery After Anesthesia

Karim¹

2021

IraqiJMS

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Background: Delayed recovery from anesthesia is one of the important challenges that face anesthesiologist. The time of delayed recovery from anesthesia is related to anesthetic agent, patient, duration and type of surgery. Objective: To determine the factors from the patients and other things related to delayed recovery after giving anesthesia. Methods: A total of 286 patients were observed in Shar Medical Hospital and Cardiac Center in Sulaimani city, Iraq between November 2019 and March 2020. Post-operative evaluation and observation were collected for delayed and normal recovery after anesthesia. P value less than 0.05 means significant relationship were obtained between variables. Results: From the 286 patients, 180 (62.94%) were male, in which 66 of them were have delayed recovery and significant relation was found p=0.005. Most of the patients were >50 years-old 126 (44.05%) and there was significant relation between age and delayed recovery of consciousness p=0.01. Delayed recovery was found among overweight more frequently than the underweight and normal weight (51 from 73 for overweight, 33 from 45 and 7 from 168, respectively). Also, significant relationship was found p=0.001. Conclusion: Old age, male, obese patients and cigarette smokers, diabetes mellitus, cerebrovascular accident, history of myocardial infarction, hyperlipidemia, and neurological diseases are high risk factors for delayed recovery. Keywords: Anesthesia, delayed recovery, post-operative care, risk factors Citation: Karim SB. Factors related to delayed recovery after anesthesia. Iraqi JMS. 2021; 19(1): 39-48. doi: 10.22578/IJMS.19.1.6

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Delayed recovery due to exaggerated acid, base and electrolyte imbalance in prolonged laparoscopic repair of diaphragmatic hernia

Cited by 6 publications

References 7 publications

Delayed recovery from anesthesia: A postgraduate educational review

Delayed recovery from anesthesia: A postgraduate educational review

Evaluation of blood electrolyte alterations in cats during elec-tive laparoscopic ovariectomy

Factors Related to Delayed Recovery After Anesthesia

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