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Delayed Emergence from Anesthesia

MedGen UID:
101047
•Concept ID:
C0520757
•
Pathologic Function
Synonyms: Awakening, Post-Anesthesia Delayed; Awakenings, Post-Anesthesia Delayed; Delayed Awakening from Anesthesia; Delayed Awakening, Post Anesthesia; Delayed Awakening, Post Procedural; Delayed Awakening, Post-Anesthesia; Delayed Awakening, Post-Procedural; Delayed Awakenings, Post-Anesthesia; Delayed Awakenings, Post-Procedural; Delayed Recovery from Anesthesia; Delayed Regaining of Consciousness; Delayed Return of Consciousness; Paralyses, Post-Anesthesia Residual; Paralysis, Post-Anesthesia Residual; Post-Anesthesia Delayed Awakening; Post-Anesthesia Delayed Awakenings; Post-Anesthesia Residual Paralyses; Post-Anesthesia Residual Paralysis; Post-Procedural Delayed Awakening; Post-Procedural Delayed Awakenings; Residual Paralyses, Post-Anesthesia; Residual Paralysis, Post Anesthesia; Residual Paralysis, Post-Anesthesia

Definition

Abnormally slow pace of regaining CONSCIOUSNESS after general anesthesia (ANESTHESIA, GENERAL) usually given during surgical procedures. This condition is characterized by persistent somnolence. [from MeSH]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVDelayed Emergence from Anesthesia

Professional guidelines

PubMed

Over- and under-treatment of TB patients in Eastern China: an analysis based on health insurance claims data.
Mao W, Jiang W, Hamilton C, Zhang H, Huang F, Lucas H, Huan S, Tang S
Trop Med Int Health 2019 Sep;24(9):1078-1087. Epub 2019 Jul 29 doi: 10.1111/tmi.13287. PMID: 31299130Free PMC Article
Neostigmine as an antagonist of residual block: best practices do not guarantee predictable results.
Murphy GS, Kopman AF
Br J Anaesth 2018 Aug;121(2):335-337. Epub 2018 May 30 doi: 10.1016/j.bja.2018.05.003. PMID: 30032868
Residual neuromuscular blockade: management and impact on postoperative pulmonary outcome.
Fuchs-Buder T, Nemes R, Schmartz D
Curr Opin Anaesthesiol 2016 Dec;29(6):662-667. doi: 10.1097/ACO.0000000000000395. PMID: 27755128

Recent clinical studies

Etiology

Sugammadex Versus Neostigmine for Reversal of Residual Neuromuscular Blocks After Surgery: A Retrospective Cohort Analysis of Postoperative Side Effects.
Ruetzler K, Li K, Chhabada S, Maheshwari K, Chahar P, Khanna S, Schmidt MT, Yang D, Turan A, Sessler DI
Anesth Analg 2022 May 1;134(5):1043-1053. doi: 10.1213/ANE.0000000000005842. PMID: 35020636
Randomised controlled trial of sugammadex or neostigmine for reversal of neuromuscular block on the incidence of pulmonary complications in older adults undergoing prolonged surgery.
Togioka BM, Yanez D, Aziz MF, Higgins JR, Tekkali P, Treggiari MM
Br J Anaesth 2020 May;124(5):553-561. Epub 2020 Mar 2 doi: 10.1016/j.bja.2020.01.016. PMID: 32139135
Delayed Emergence From Anesthesia: A Simulation Case for Anesthesia Learners.
Ellis TA, Edberg JL, Kumar N, Applefield DJ
MedEdPORTAL 2017 Sep 18;13:10628. doi: 10.15766/mep_2374-8265.10628. PMID: 30800829Free PMC Article
Delayed emergence after anesthesia.
Tzabazis A, Miller C, Dobrow MF, Zheng K, Brock-Utne JG
J Clin Anesth 2015 Jun;27(4):353-60. Epub 2015 Apr 23 doi: 10.1016/j.jclinane.2015.03.023. PMID: 25912729
Independent predictors of delay in emergence from general anesthesia.
Maeda S, Tomoyasu Y, Higuchi H, Ishii-Maruhama M, Egusa M, Miyawaki T
Anesth Prog 2015 Spring;62(1):8-13. doi: 10.2344/0003-3006-62.1.8. PMID: 25849468Free PMC Article

Diagnosis

Sugammadex Versus Neostigmine for Reversal of Residual Neuromuscular Blocks After Surgery: A Retrospective Cohort Analysis of Postoperative Side Effects.
Ruetzler K, Li K, Chhabada S, Maheshwari K, Chahar P, Khanna S, Schmidt MT, Yang D, Turan A, Sessler DI
Anesth Analg 2022 May 1;134(5):1043-1053. doi: 10.1213/ANE.0000000000005842. PMID: 35020636
Dopamine D1 receptor in the NAc shell is involved in delayed emergence from isoflurane anesthesia in aged mice.
Zhang Y, Gui H, Hu L, Li C, Zhang J, Liang X
Brain Behav 2021 Jan;11(1):e01913. Epub 2020 Oct 22 doi: 10.1002/brb3.1913. PMID: 33094567Free PMC Article
Delayed Emergence From Anesthesia: A Simulation Case for Anesthesia Learners.
Ellis TA, Edberg JL, Kumar N, Applefield DJ
MedEdPORTAL 2017 Sep 18;13:10628. doi: 10.15766/mep_2374-8265.10628. PMID: 30800829Free PMC Article
Delayed emergence after anesthesia.
Tzabazis A, Miller C, Dobrow MF, Zheng K, Brock-Utne JG
J Clin Anesth 2015 Jun;27(4):353-60. Epub 2015 Apr 23 doi: 10.1016/j.jclinane.2015.03.023. PMID: 25912729
Brain areas that influence general anesthesia.
Leung LS, Luo T, Ma J, Herrick I
Prog Neurobiol 2014 Nov;122:24-44. Epub 2014 Aug 27 doi: 10.1016/j.pneurobio.2014.08.001. PMID: 25172271

Therapy

Sugammadex Versus Neostigmine for Reversal of Residual Neuromuscular Blocks After Surgery: A Retrospective Cohort Analysis of Postoperative Side Effects.
Ruetzler K, Li K, Chhabada S, Maheshwari K, Chahar P, Khanna S, Schmidt MT, Yang D, Turan A, Sessler DI
Anesth Analg 2022 May 1;134(5):1043-1053. doi: 10.1213/ANE.0000000000005842. PMID: 35020636
Randomised controlled trial of sugammadex or neostigmine for reversal of neuromuscular block on the incidence of pulmonary complications in older adults undergoing prolonged surgery.
Togioka BM, Yanez D, Aziz MF, Higgins JR, Tekkali P, Treggiari MM
Br J Anaesth 2020 May;124(5):553-561. Epub 2020 Mar 2 doi: 10.1016/j.bja.2020.01.016. PMID: 32139135
Residual Neuromuscular Blockade.
Plummer-Roberts AL, Trost C, Collins S, Hewer I
AANA J 2016 Feb;84(1):57-65. PMID: 26939390
Independent predictors of delay in emergence from general anesthesia.
Maeda S, Tomoyasu Y, Higuchi H, Ishii-Maruhama M, Egusa M, Miyawaki T
Anesth Prog 2015 Spring;62(1):8-13. doi: 10.2344/0003-3006-62.1.8. PMID: 25849468Free PMC Article
The concept behind sugammadex.
Epemolu O, Bom A
Rev Esp Anestesiol Reanim 2014 May;61(5):272-6. Epub 2014 Mar 15 doi: 10.1016/j.redar.2014.02.001. PMID: 24636599

Prognosis

Epidemiology and outcomes of residual neuromuscular blockade: A systematic review of observational studies.
Raval AD, Anupindi VR, Ferrufino CP, Arper DL, Bash LD, Brull SJ
J Clin Anesth 2020 Nov;66:109962. Epub 2020 Jun 22 doi: 10.1016/j.jclinane.2020.109962. PMID: 32585565
Evaluation of Safety and Short-term Outcomes of Therapeutic Rigid Bronchoscopy Using Total Intravenous Anesthesia and Spontaneous Assisted Ventilation.
Murgu S, Laxmanan B, Stoy S, Egressy K, Chaddha U, Farooqui F, Brunner R, Hogarth K, Chaney M
Respiration 2020;99(3):239-247. Epub 2019 Dec 18 doi: 10.1159/000504679. PMID: 31851991
Residual neuromuscular blockade: management and impact on postoperative pulmonary outcome.
Fuchs-Buder T, Nemes R, Schmartz D
Curr Opin Anaesthesiol 2016 Dec;29(6):662-667. doi: 10.1097/ACO.0000000000000395. PMID: 27755128
Do we really need sugammadex as an antagonist of muscle relaxants in anesthesia?
Meistelman C, Donati F
Curr Opin Anaesthesiol 2016 Aug;29(4):462-7. doi: 10.1097/ACO.0000000000000359. PMID: 27168088
Independent predictors of delay in emergence from general anesthesia.
Maeda S, Tomoyasu Y, Higuchi H, Ishii-Maruhama M, Egusa M, Miyawaki T
Anesth Prog 2015 Spring;62(1):8-13. doi: 10.2344/0003-3006-62.1.8. PMID: 25849468Free PMC Article

Clinical prediction guides

Effect of Caffeine on the Acceleration of Emergence from General Anesthesia with Inhalation Anesthetics in Children Undergoing Inguinal Herniorrhaphy: A Randomized Clinical Trial.
Emami S, Panah A, Hakimi SS, Sahmeddini MA
Iran J Med Sci 2022 Mar;47(2):107-113. doi: 10.30476/IJMS.2021.87688.1818. PMID: 35291434Free PMC Article
Fatty Liver Is an Independent Risk Factor for Delayed Recovery from Anesthesia.
Shapses M, Tang L, Layne A, Beri A, Rotman Y
Hepatol Commun 2021 Nov;5(11):1848-1859. Epub 2021 Jul 15 doi: 10.1002/hep4.1772. PMID: 34558821Free PMC Article
Epidemiology and outcomes of residual neuromuscular blockade: A systematic review of observational studies.
Raval AD, Anupindi VR, Ferrufino CP, Arper DL, Bash LD, Brull SJ
J Clin Anesth 2020 Nov;66:109962. Epub 2020 Jun 22 doi: 10.1016/j.jclinane.2020.109962. PMID: 32585565
Independent predictors of delay in emergence from general anesthesia.
Maeda S, Tomoyasu Y, Higuchi H, Ishii-Maruhama M, Egusa M, Miyawaki T
Anesth Prog 2015 Spring;62(1):8-13. doi: 10.2344/0003-3006-62.1.8. PMID: 25849468Free PMC Article
The effect of preoperative consumption of potatoes on succinylcholine-induced block and recovery from anesthesia.
Bestas A, Goksu H, Erhan OL
J Clin Monit Comput 2013 Dec;27(6):609-12. Epub 2013 May 23 doi: 10.1007/s10877-013-9476-z. PMID: 23700201

Recent systematic reviews

Epidemiology and outcomes of residual neuromuscular blockade: A systematic review of observational studies.
Raval AD, Anupindi VR, Ferrufino CP, Arper DL, Bash LD, Brull SJ
J Clin Anesth 2020 Nov;66:109962. Epub 2020 Jun 22 doi: 10.1016/j.jclinane.2020.109962. PMID: 32585565
Neostigmine-based reversal of intermediate acting neuromuscular blocking agents to prevent postoperative residual paralysis: A systematic review.
Tajaate N, Schreiber JU, Fuchs-Buder T, Jelting Y, Kranke P
Eur J Anaesthesiol 2018 Mar;35(3):184-192. doi: 10.1097/EJA.0000000000000741. PMID: 29189420
The efficacy and safety of sugammadex for reversing postoperative residual neuromuscular blockade in pediatric patients: A systematic review.
Liu G, Wang R, Yan Y, Fan L, Xue J, Wang T
Sci Rep 2017 Jul 18;7(1):5724. doi: 10.1038/s41598-017-06159-2. PMID: 28720838Free PMC Article

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