Delayed Emergence from Anesthesia: What We Know and How We Act.

IF 1.5 Q3 ANESTHESIOLOGY Local and Regional Anesthesia Pub Date : 2020-11-05 eCollection Date: 2020-01-01 DOI:10.2147/LRA.S230728
Marco Cascella, Sabrina Bimonte, Raffaela Di Napoli
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引用次数: 30

Abstract

The emergence from anesthesia is the stage of general anesthesia featuring the patient's progression from the unconsciousness status to wakefulness and restoration of consciousness. This complex process has precise neurobiology which differs from that of induction. Despite the medications commonly used in anesthesia allow recovery in a few minutes, a delay in waking up from anesthesia, called delayed emergence, may occur. This phenomenon is associated with delays in the operating room, and an overall increase in costs. Together with the emergence delirium, the phenomenon represents a manifestation of inadequate emergence. Nevertheless, in delayed emergence, the transition from unconsciousness to complete wakefulness usually occurs along a normal trajectory, although slowed down. On the other hand, this awakening trajectory could proceed abnormally, possibly culminating in the manifestation of emergence delirium. Clinically, delayed emergence often represents a challenge for clinicians who must make an accurate diagnosis of the underlying cause to quickly establish appropriate therapy. This paper aimed at presenting an update on the phenomenon, analyzing its causes. Diagnostic and therapeutic strategies are addressed. Finally, therapeutic perspectives on the "active awakening" are reported.

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麻醉延迟苏醒:我们所知道的和我们如何行动。
麻醉苏醒期是全麻过程中患者从昏迷状态到清醒状态并恢复意识的阶段。这个复杂的过程具有与诱导不同的精确的神经生物学。尽管麻醉中常用的药物可以在几分钟内恢复,但可能会出现从麻醉中醒来的延迟,称为延迟苏醒。这种现象与手术室的延误和成本的总体增加有关。与涌现性谵妄一起,这种现象代表了涌现性不足的表现。然而,在延迟出现中,从无意识到完全清醒的过渡通常沿着正常的轨迹发生,尽管速度会减慢。另一方面,这种觉醒轨迹可能不正常地进行,可能以出现谵妄的表现达到高潮。临床上,延迟出现通常对临床医生来说是一个挑战,他们必须准确诊断潜在原因,以便迅速建立适当的治疗方法。本文旨在介绍这一现象的最新情况,并分析其原因。讨论了诊断和治疗策略。最后,对“主动觉醒”的治疗观点进行了报道。
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来源期刊
CiteScore
6.30
自引率
0.00%
发文量
12
审稿时长
16 weeks
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