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Delayed Emergence in Pediatric Patients
Case Synopsis
A 2-year-old 14-kg girl with trisomy 21 remains unresponsive and intubated in the operating room 35 minutes after anesthetic agents were discontinued following adenotonsillectomy for obstructive sleep apnea. Intraoperatively she received propofol 2 mg/kg -1 , morphine 0.1 mg/kg -1 , and cisatracurium 0.2 mg/kg -1 . General anesthesia was maintained with sevoflurane 2.5% in a mixture of oxygen and air (Fi o 2 0.6). Neuromuscular blockade was antagonized with glycopyrrolate 0.01 mg/kg -1 and neostigmine 0.05 mg/kg -1 .
Acknowledgment
The authors wish to thank Dr. Hector Nicodemus for his contribution to the previous edition of this chapter.
Problem Analysis
Definition
Delayed emergence is defined as failure to recover consciousness after discontinuation of general anesthesia within a reasonable amount of time, in most cases less than 30 minutes. The time it takes to recover consciousness is variable and depends on several factors, such as the length of the procedure, the agents and techniques used, and the patient’s preoperative physical and mental status.
Recognition
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