Delayed Awakening Flashcards
1
Q
What is the definition of delayed awakening?
A
Delayed return of consciousness as compared to what was expected for a given anesthetic.
2
Q
What are the clinical features of delayed awakening?
A
absence of purposeful movements of response to stimuli
3
Q
What ipharmacologic causes are in the differential diagnosis of delayed awakening?
A
residual drugs premedication (benzos, antihistamines) induction/anesthetic agents muscle relaxants decreased metabolism, excretion, protein binding increased drug sensitivity elderly drug interactions renal/hepatic disease hypothermia biologic variability
4
Q
What metabolic causes are in the differential diagnosis for delayed awakening?
A
renal/hepatic disease (encephalopathy, metabolism-->residual drug) hypothyroidism/myxedema coma adrenal insufficiency hypoxemia hypercapnia hypoglycemia hypothermia hyponatremia sepsis malignant hyperthermia
5
Q
What neurologic causes are in the differential diagnosis for delayed awakening?
A
hypoperfusion decreased cardiac output cerebrovascular disease embolism, thrombus, retraction hyperperfusion (e.g., ICH) increased ICP cerebral edema undetected head injury
6
Q
What is the management of delayed awakening?
A
- scan monitors and ensure adequate O2 and ventilation
- check that all anesthetics have been turned off
- stimulate the patient with gentle suction
- if combative use physical restraints until etiology ruled out
- r/o metabolic causes
finger stick for glucose
check temp
send stat electrolytes and ABG
-review medication doses, check for syringe swap - consider reversing (naloxone, flumazenil, train-of-four)
- perform neuro exam
- consult neurology; admit to ICU
7
Q
What dose of flumazenil would you give to reverse benzodiazepines?
A
0.2mg q1minute up to 1mg
8
Q
What dose of naloxone would you give to reverse opioids in the setting of delayed awakening?
A
naloxone 0.04mg q1min up to 0.4mg
