An elderly man in his eighties underwent lumbar spine surgery, and the surgeon told the family that the surgery only took one hour to ensure their peace of mind. As a result, the patient is elderly and has underlying conditions such as hypertension and coronary heart disease before surgery. After waking up for an hour and a half, they are still not fully awake, causing anxiety and concern among their family members.
There is a saying in the field of anesthesiology that 'only minor surgeries, no minor anesthesia'. That is to say, in the eyes of surgeons, surgery can be big or small, but in the eyes of anesthesiologists, every anesthesia comes with risks, and we must strive to ensure the safety of patients' lives. The development of surgery cannot be separated from the contribution of anesthesiologists. Thanks to the strong backing of anesthesiologists, surgeons can perform surgeries without any worries, without worrying about whether patients experience pain or if their vital signs are abnormal during the surgery.
The postoperative recovery of patients is the primary indicator for evaluating postoperative tracheal intubation, and it is also the most convenient and important observation indicator for early diagnosis of postoperative neurological damage. Delayed awakening leads to prolonged mechanical ventilation and intensive care time, increasing the risk of other complications and even leading to patient death, which brings huge economic burden to patients and their families.
Therefore, we need to clarify the reasons that affect patients' delayed awakening and help them wake up on time.
Why do some patients take longer to wake up?
Generally, after general anesthesia surgery, the infusion of anesthetics is stopped, and the patient will wake up within 60-90 minutes, restoring movement instructions, orientation, and preoperative memory. If the patient still cannot wake up after this time limit, it can be evaluated as delayed anesthesia awakening.
Delayed awakening factors?
Age: Elderly people (≥ 60 years old) have degenerative changes in organ function and are more sensitive to anesthetics than younger people. In addition, reduced liver blood flow and decreased metabolism and absorption of anesthetic drugs in the elderly may enhance or prolong the effects of anesthetic drugs. In addition, elderly people often have more complications and high psychological pressure, which can affect the recovery of anesthesia. Therefore, when taking medication for the elderly, it is best to reduce the dosage according to their physical condition.
Long operation time and low body temperature: Long operation time means exposure of the chest and abdomen, long anesthesia time, and a large amount of intravenous infusion and abdominal flushing during the operation, which will weaken the body's thermoregulatory effect through dual effects on the central and peripheral nervous systems. Hypothermia suppresses the central nervous system and significantly reduces blood flow to muscles, liver, kidneys, and other areas, thereby slowing down the metabolism and clearance of anesthetic drugs, ultimately leading to delayed postoperative recovery.
Hypoxia and CO2 accumulation: During anesthesia, respiratory dysfunction in patients can cause hypoxia, which can occur during surgery or immediately after surgery. CO2 accumulation is often due to residual effects of drugs or some degree of hypoxia during anesthesia, mostly occurring in patients undergoing laparoscopic surgery and those with high end tidal PCO2 during surgery. If the patient also has low blood volume and acidosis in the presence of postoperative hypoxia, it is more likely to cause delayed recovery.
Preoperative sleep deprivation: Severe preoperative sleep deprivation can lead to delayed postoperative recovery. This is because a certain degree of sleep deprivation increases the effectiveness of anesthesia, which, like natural sleep, can effectively eliminate sleep debt. The sleep mechanism suggests that neuronal activity consumes energy during wakefulness and recovers during sleep. Meanwhile, neuronal activity during wakefulness leads to increased energy expenditure and adenosine concentration, thereby inhibiting neuronal activity and inducing sleep.
How can patients quickly recover?
When encountering patients with delayed awakening, the first step is to ensure that the patient's airway is unobstructed, ventilation is sufficient, oxygen is given, and SpO2, PetCO2, and arterial blood gas are monitored. If necessary, invasive or non-invasive methods should be used to control breathing. Check the patient's biochemical levels such as electrolytes, blood glucose, and urine routine.
Then it is necessary to eliminate the causes of delayed awakening one by one, starting with prolonging the action time of anesthetics. Based on the patient's surgical and anesthesia process, as well as the type and dosage of anesthesia, pupil constriction and reduced respiratory rate are some manifestations of opioid residue. If necessary, a muscle relaxation monitor can be used to detect muscle relaxation status.
In such patients, drug excretion can be increased through ventilation or fluid replacement, and relevant antagonists such as neostigmine, atropine, and naloxone can be used according to the instructions of the anesthesiologist.
For delayed awakening caused by hypoglycemia, electrolyte imbalance, hypothermia, etc., timely correction is sufficient.
Finally, for patients with unknown causes, it is crucial to be alert to neurological damage, so we need to examine their neurological symptoms and strengthen monitoring. Early judgment is easily disrupted by the effects of anesthetic drugs, but as the anesthetic drugs are eliminated, signs of neurological damage localization may eventually appear. If necessary, a neurologist can be consulted.