long term side effects of general anesthesia after surgery

Studies have shown that demand for opioids is reduced by almost 50% in geriatric patients. This comprehensive review discusses the risk factors, causes, evaluation and management of delayed recovery based on our clinical experience, and literature search on the internet, supported by the standard textbooks of anesthesiology.Įlderly patients have increased sensitivity toward general anesthetics, opioids and benzodiazepines, and slow return of consciousness due to progressive decline in central nervous system (CNS) function. Since day-care surgery is gaining a great popularity day by day, adequate recovery time and a high vigilance to rare side effects becomes more and more important. The most important monitor is a well-informed and skilled person, with immediate access to anesthetic assistance. Higher incidence of early postoperative respiratory complications is noted when the patient returns unresponsive in recovery room irrespective of age or American Society of Anesthesiologist category. Patients should not leave the operating room unless they have stable hemodynamic parameters, a patent airway, have adequate ventilation, and oxygenation. Recovery from intravenous (IV) opioids and hypnotics may be more variable and difficult to quantify than recovery from inhalational and neuromuscular blocking agents. Patients usually respond to verbal stimuli when alveolar anesthetic concentration is decreased to about 30% of minimum alveolar concentration (MAC) (MAC awake) if unimpeded by other factors.

“Recovery from anesthesia may be defined as a state of consciousness of an individual when he is awake or easily arousable and aware of his surroundings and identity.” Awakening results from elimination of anesthetic agents from the brain. This comprehensive review discusses the risk factors, causes, evaluation and management of delayed recovery based on our clinical experience, and literature search on the internet, supported by the standard textbooks of anesthesiology. Accurate diagnosis of the underlying cause is the key for the institution of appropriate therapy, but primary management is to maintain airway, breathing, and circulation. Unexpected delayed emergence after general anesthesia may also be due to intraoperative cerebral hypoxia, hemorrhage, embolism, or thrombosis. Certain underlying metabolic disorders such as hypoglycemia, severe hyperglycemia, and electrolyte imbalance, especially hypernatremia, hypoxia, hypercapnia, central anticholinergic syndrome, chronic hypertension, liver disease, hypoalbuminemia, uremia, and severe hypothyroidism may also be responsible for delayed recovery following anesthesia. Nonpharmacological causes may have a serious sequel, hence recognizing these organic conditions is important.

The principal factors responsible for delayed awakening following anesthesia are anesthetic agents and medications used in the perioperative period. The time to emerge from anesthesia is affected by patient factors, anesthetic factors, duration of surgery, and painful stimulation. With the general use of fast-acting anesthetic agents, patients usually awaken quickly in the postoperative period. Delayed awakening from anesthesia remains one of the biggest challenges that involve an anesthesiologist.

Long term side effects of general anesthesia after surgery