Delayed recovery of consciousness after general anaesthesia

Background: The main aims of pre-anaesthetic medication are anxiolysis, analgesia, anti-emesis and reducing perioperative patient risk. Producing a state of amnesia for pre and post-operative events is desired by all. This study has been undertaken to evaluate the role of three of the benzodiazepines i.e. diazepam, lorazepam and midazolam during general anaesthesia, in providing anxiolysis, sedation and amnesia.Methods: The study included patients with ASA grade I and ASA grade II physical status of both sexes, age ranging between 18-60 years. Patients were divided into three groups of thirty patients each, every group receiving intramuscular injections of diazepam 0.1 mg/kg body weight, lorazepam 0.07 mg/kg body weight and midazolam 0.08 mg/kg body weight respectively; 45 minutes prior to induction of general anaesthesia. Anxiety assessment before premedication along with assessment of sedation after premedication was done.Results: Before premedication the mean values of pulse rate, blood pressure and respiratory rate were not significantly different among the three groups (p>0.05). Maximum changes in these parameters were observed with Midazolam followed by lorazepam and diazepam. The dose of thiopentone used as inducing agent was also lowered significantly in case of midazolam (p<0.05). One patient in midazolam group showed respiratory depression whereas four patients receiving lorazepam and diazepam showed delayed recovery and prolonged sedation, but the effects were self-limiting.Conclusions: Midazolam offers the maximum advantage in allaying anxiety and providing excellent sedation and amnesia during general anaesthesia and proves to be the most suitable premedicant before general anaesthesia.

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Delayed recovery from general anaesthesia associated with pre‐existing neurological disease in a horse

Veterinary Record Case Reports ◽

10.1136/vetreccr-2019-000969 ◽

2019 ◽

Vol 7 (4) ◽

Author(s):

Samuel Lord ◽

Caroline Hahn ◽

Patrick J Pollock ◽

Juliet Clare Duncan

Keyword(s):

General Anaesthesia ◽

Neurological Disease ◽

Delayed Recovery

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Anaesthesia for Renal Transplantation — 5 Years’ Experience

Anaesthesia and Intensive Care ◽

10.1177/0310057x8301100405 ◽

1983 ◽

Vol 11 (4) ◽

pp. 337-344 ◽

Cited By ~ 10

Author(s):

A. R. Marsland ◽

J. P. Bradley

Keyword(s):

General Anaesthesia ◽

Medical Records ◽

Anaesthetic Management ◽

Cardiac Complications ◽

New Agents ◽

High Incidence ◽

Life Threatening ◽

Delayed Recovery ◽

End Stage ◽

Biochemical Abnormalities

Two hundred and seventy patients underwent anaesthesia for 280 renal transplants between October 1977 and October 1982. Their medical records were studied retrospectively. These patients were representative of the end-stage chronic renal failure population, with the usual high incidence of cardiovascular and biochemical abnormalities. Most received general anaesthesia, with an intravenous barbiturate, muscle relaxant, narcotic and volatile supplement sequence being the most common. There were no intra-operative deaths. One postoperative death was felt to be influenced by the anaesthetic management. Four patients had life-threatening cardiac complications and a further four required postoperative respiratory support, three for delayed recovery of neuromuscular function and one for “recurarisation”. Less serious complications were considerably more common. General anaesthesia utilising suxamethonium and tubocurarine as the relaxants and halothane as the volatile supplement is least likely to result in complications. Changes to this anaesthetic sequence are likely with the introduction of new agents.

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Central anticholinergic syndrome (CAS) in anesthesiology: a narrative review

Perioperaciina Medicina ◽

10.31636/prmd.v2i1.3 ◽

2019 ◽

Vol 2 (1) ◽

pp. 22-25

Author(s):

Dmytro Dmytriiev ◽

Dmytro Bortnik

Keyword(s):

General Anesthesia ◽

Narrative Review ◽

Anticholinergic Syndrome ◽

Central Anticholinergic Syndrome ◽

Delayed Recovery ◽

Recovery Of Consciousness

Psychomotor excitation, delayed recovery of consciousness after general anesthesia – well-known conditions. But only in the literature of Germany, it was first isolated in a separate central anticholinergic syndrome (CAS). This article discusses the main aspects and symptoms that will help to differentiate this syndrome with other conditions, and the methods for relief of this state.

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Delayed recovery from general anaesthesia

Anaesthesia ◽

10.1111/j.1365-2044.1988.tb05700.x ◽

2007 ◽

Vol 43 (12) ◽

pp. 1024-1025 ◽

Cited By ~ 3

Author(s):

K. R. JOHNSTON ◽

R. S. VAUGHAN

Keyword(s):

General Anaesthesia ◽

Delayed Recovery

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Butyryl-cholinesterase deficiency: A case report of delayed recovery after general anaesthesia

Toxicology Reports ◽

10.1016/j.toxrep.2021.06.016 ◽

2021 ◽

Vol 8 ◽

pp. 1226-1228

Author(s):

Ahmed Al-Emam

Keyword(s):

Case Report ◽

General Anaesthesia ◽

Butyryl Cholinesterase ◽

Delayed Recovery

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The Efficacy of Prophylactic Intravenous Granisetron in Preventing Post Anaesthesia Shivering in Gynaecological Patients Undergoing Surgery Under General Anaesthesia

Medicine & Health ◽

10.17576/mh.2021.1601.03 ◽

2021 ◽

Vol 16 (1) ◽

pp. 20-29

Author(s):

Joanna Ooi Su Min ◽

Keyword(s):

General Anaesthesia ◽

Carbon Dioxide Production ◽

Double Blind ◽

Intravenous Anaesthetic ◽

Group A ◽

Delayed Recovery ◽

Grade 3 ◽

Group B ◽

Experienced Grade ◽

Control Study

Post-anaesthetic shivering is one of the commonest complications during emergence from general anaesthesia with the rate of occurrence between 5 to 65%. It increases oxygen consumption and carbon dioxide production resulting in delayed recovery from anaesthesia and other adverse events. Granisetron is one of the drugs used to prevent post-anaesthetic shivering. This prospective, double-blind and randomised control study compared the efficacy of prophylaxis IV granisetron at 2 mg and 3 mg doses in preventing post-anaesthetic shivering. There were 104 patients, ASA I and II scheduled for elective open gynaecological surgery recruited and randomised into 2 groups: Group A and B, receiving 2 and 3 mg of IV granisetron, resepectively. Intravenous anaesthetic drugs were administered and tracheal intubation was facilitated by muscle paralysis. Patients’ baseline and periodic tympanic core temperatures were measured perioperatively. The incidence and severity of shivering were assessed postoperatively using Wrench Scoring Classification whereby Group A and B had 8.3% and 16.7% of incidence, respectively, in which they were not statistically significant (p = 0.199). All patients from both groups who shivered experienced Grade 1 shivering except for one patient who registered a Grade 2 in Group B. None of our patients had Grade 3 or 4 shivering postoperatively. No one experienced nausea or vomiting in the recovery area. Prophylactic IV granisetron of 2 mg and 3 mg were equally effective in reducing the incidence and severity of post-anaesthetic shivering in gynaecological patients undergoing surgery under general anaesthesia with no unpleasant side effects.

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