Delayed Recovery from Anaesthesia in a Patient with Optimised Hypothyroidism and Incidental Hypokalemia

More, Preeti; Laheri, Vandana; Waigankar, Tejasi; Wagh, Charchill

doi:10.7860/jcdr/2015/10088.5410

Cited by 6 publications

(6 citation statements)

References 4 publications

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“…Although hypokalemia is often asymptomatic, it remains a risk factor of gastrointestinal disorders and serious perioperative and postoperative arrhythmia [ 16 – 19 ]. Hypokalemia might also contribute to delayed recovery from anesthesia [ 20 ], as well as increasing the length of hospital stay and the risk for all-cause and cardiovascular-related mortality [ 5 , 21 ]. Among our study group, the time to first feces was significantly longer among patient with than without hypokalemia.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors for hypokalemia in patients scheduled for laparoscopic colorectal resection and its association with post-operative recovery

Zhu

Tan

et al. 2018

BMC Gastroenterol

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BackgroundPerioperative serum potassium levels are closely associated with postoperative clinical outcomes after gastrointestinal surgery. The aim of our retrospective study was to identify the prevalence and risk factors for preoperative hypokalemia (before pneumoperitoneum) and to evaluate the influence of preoperative hypokalemia on the recovery of postoperative gastrointestinal function.MethodsIn this retrospective study, patients scheduled for laparoscopic colorectal resection from November 11 2014 to October 20 2016, were considered for inclusion. A blood potassium level between 3.5 and 5.5 mmol/L was defined as normal, with levels between 3.0 to 3.5 mmol/L, 2.5 to 3.0 mmol/L and < 2.5 mmol/L considered as slight, moderate, and severe level of hypokalemia. The factors including age, gender, ASA grade, BMI, hypertension, diabetes, anti-hypertension drugs, lactose oral soluble, oral cathartics, oral cathartics, cathartic enemas, and blood potassium level before gastrointestinal preparation which might be associated with blood potassium level before pneumoperitoneum were analysed. The time to postoperative first flatus (FFL) and first feces (FFE) was compared between patients with and without hypokalemia.ResultsThe final analysis was based on the data of 108 patients. Hypokalemia was identified in 70.37% patients, with the following distribution of blood potassium levels before pneumoperitoneum: slight, 49 (45.37%) patients; moderate, 23 (21.30%); and severe, 4 (3.70%) patients. Hypokalemia was significantly associated with hypertension and the use of ≥2 types of oral cathartics for preoperative gastrointestinal preparation. With treatment, potassium levels recovered to normal levels in all patients within 48 h postoperatively. Hypokalemia was associated with a longer postoperative time to first feces, compared to patients with a normal potassium level before pneumoperitoneum.ConclusionsOur findings underlie the importance of early monitoring and management of serum potassium levels in these patients.

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Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors for hypokalemia in patients scheduled for laparoscopic colorectal resection and its association with post-operative recovery

Zhu

Tan

et al. 2018

BMC Gastroenterol

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“…Delayed recovery due to inadvertent hypokalemia after laparoscopic cholecystectomy is reported in a medically optimized case of hypertension, bronchial asthma, and hypothyroidism. [ 33 ] Hypokalemia intensifies the effects of nondepolarizing muscle relaxants. Respiratory alkalosis with PaCO 2 <36 mmHg results in reduced intracellular proton concentration and draws K + into the cells.…”

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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“…Certain underlying organ dysfunction and metabolic disorders may also cause delayed awakening following anesthesia, such as old age, liver disease, renal disease, hypoalbuminemia, electrolyte imbalance, hyper/ hypo-glycemia, and hypoxia. [10,12,13] In this study, there were 6 (30%) patients with delayed discharge from the PACU due to delayed awakening from anesthesia in the PACU. The factors included major and longer procedures (three liver surgeries, 2 thoracic surgeries, and 1 vascular surgery), old age (12 [60%] cases ≥ 65 years), use of high-dose opioids and anesthetics, and hypothermia.…”

Section: Discussionmentioning

confidence: 81%

Delayed discharge from post-anesthesia care unit: A 20-case retrospective series

Liu,

Zhang,

Cai

et al. 2023

Medicine

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Objective: To summarize the characteristics of patients with delayed discharge from the post-anesthesia care unit and to analyze the factors and outcomes of delayed discharge. Methods: Twenty cases of delayed discharge from the PACU (PACU stay >2 hours after surgery) of the main operating room in Liaocheng People’s Hospital, a class A tertiary comprehensive hospital, between January 1, 2021, and December 31, 2022, among 28,084 patients who were transferred to the PACU from the operating rooms after surgery, were retrospectively analyzed. The collected data included patient characteristics, American society of anesthesiologists grade, information related to surgery and anesthesia, and outcomes. The factors for delay were assigned to 1 of 6 groups: delayed recovery from anesthesia, surgical complications, cardiovascular instability, hypoxia, inadequate analgesia, and waiting for the operating room. Results: The incidence of delayed discharge from PACU was 0.7‰. Among 20 patients, more than half of the patients were over 65 years of age, American society of anesthesiologists grade II~III, body mass index <30 kg/m2, and urological surgery (7, 35%), liver surgery (4, 20%), thoracic surgery (4, 20%) accounted for a relatively high proportion. Nineteen (95%) patients received general anesthesia with or without peripheral nerve block. The main factors included delayed recovery from anesthesia (6, 30%), surgical complications (5, 25%), cardiovascular complications (4, 20%), hypoxia (3,15%). After discharge from the PACU, 1 (5%) died in the intensive care unit, and the other 19 (95%) patients were safely discharged from the hospital. Conclusion: The incidence of delayed discharge from the PACU was low, and it was more likely to occur in the elderly, during major operations, and under general anesthesia. Delayed recovery from anesthesia was the most common factor. Most patients were safely discharged from the hospital.

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Delayed Recovery from Anaesthesia in a Patient with Optimised Hypothyroidism and Incidental Hypokalemia

Cited by 6 publications

References 4 publications

Prevalence and risk factors for hypokalemia in patients scheduled for laparoscopic colorectal resection and its association with post-operative recovery

Prevalence and risk factors for hypokalemia in patients scheduled for laparoscopic colorectal resection and its association with post-operative recovery

Delayed recovery from anesthesia: A postgraduate educational review

Delayed discharge from post-anesthesia care unit: A 20-case retrospective series

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