Summary

In study session IV you have learnt

• Emergence is the period of recovery from anesthesia which occurs from the termination of the anesthetic until the patient is able to respond to verbal stimuli. At the end of anesthesia and surgery the patient should be awake or easily rousable, protecting their airway, maintaining adequate ventilation and with their pain under control.
• Recovery from general or regional anesthesia is a time of great physiological stress for many patients. Emergence from general anesthesia should ideally be a smooth and gradual awakening in a controlled environment.
• Emergence excitement is characterized by tachycardia, restlessness, disorientation, altered pain responsiveness, crying, moaning, and irrational talking during recovery from general anesthesia. In some cases, patients become delirious, shout, scream and trash about, posing a danger to themselves and recovery room staff.
• Recall of intraoperative events can generate severe panic and anxiety during emergence. Pain amplifies agitation, confusion, and aggressive behavior during emergence; therefore, it is helpful to ensure adequate postoperative analgesia.
• Ketamine can cause dysphoria and hallucination Administration of ketamine with combination diazepam may be indicated to limit the unpleasant emergence reactions and also increase amnesia.
• Advantages of extubation during deep anesthesia include no coughing or straining against suture lines or incisions and removal of the endotracheal tube before it leads to airway reactivity, both of which lead to a smoother emergence. Deep extubation increases the risk for vomiting and aspiration.
• Experience and close communication with the surgeon enable the anesthetist to predict the time at which the application of dressings and casts will be complete. In advance of that time, anesthetic vapors have been decreased or even switched off entirely to allow time for them to be excreted by the lungs.
• Always reverse a nondepolarizing muscle relaxant, even if you think the relaxant has worn off. Patients given a muscle relaxant will frequently have residual muscle relaxation at the end of the surgical procedure.
• Before tracheal extubation, preoxygenation to fill the functional residual capacity with oxygen allow for the longest safe period should breath- holding or laryngospasm occur immediately after tracheal extubation.
• Causes of delayed emergence includes over dose of anesthetics, narcotics and muscle relaxants. Metabolic disorders (hypoglycemia), coexisting medical problems, intraoperative hyperventilation and severe hypothermia also delays awakening
• Care of delayed emergence includes maintenance of clear airway, oxygenation and ventilation, reintubate if necessary, assess the vital sign including pulse oximeter, consult seniors and look for causes and treat causes.
• Patients should not leave the operating room unless they have a stable and patent airway, have adequate ventilation and oxygenation, and are hemodynamically stable. Supplemental oxygen should be administered during transport to patients at risk for hypoxemia.