Delayed Emergence from Anesthesia

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

Also Known As:

Delayed Awakening, Post-Procedural; Delayed Recovery from Anesthesia; Delayed Regaining of Consciousness; Delayed Return of Consciousness; Postoperative Residual Curarisation; Postoperative Residual Curarization; Postoperative Residual Weakness; Residual Block; Residual Neuromuscular Block; Residual Neuromuscular Blockade; Residual Paralysis, Post-Anesthesia; Awakening, Post-Anesthesia Delayed; Awakenings, Post-Anesthesia Delayed; Block, Residual; Block, Residual Neuromuscular; Blockade, Residual Neuromuscular; Blockades, Residual Neuromuscular; Blocks, Residual; Blocks, Residual Neuromuscular; Curarization, Postoperative Residual; Curarizations, Postoperative Residual; Delayed Awakening, Post Anesthesia; Delayed Awakening, Post Procedural; Delayed Awakenings, Post-Anesthesia; Delayed Awakenings, Post-Procedural; Neuromuscular Block, Residual; Neuromuscular Blockade, Residual; Neuromuscular Blockades, Residual; Neuromuscular Blocks, Residual; 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; Postoperative Residual Curarisations; Postoperative Residual Curarizations; Postoperative Residual Weaknesses; Residual Blocks; Residual Curarisation, Postoperative; Residual Curarisations, Postoperative; Residual Curarization, Postoperative; Residual Curarizations, Postoperative; Residual Neuromuscular Blockades; Residual Neuromuscular Blocks; Residual Paralyses, Post-Anesthesia; Residual Paralysis, Post Anesthesia; Residual Weakness, Postoperative; Residual Weaknesses, Postoperative; Weakness, Postoperative Residual; Weaknesses, Postoperative Residual; Delayed Awakening from Anesthesia; Delayed Awakening, Post-Anesthesia

Networked: 383 relevant articles (9 outcomes, 39 trials/studies)

Relationship Network

Disease Context: Research Results

Signs and Symptoms Pathological Conditions
- Pathologic Processes: 10385
  - Postoperative Complications
    - Delayed Emergence from Anesthesia: 383

Related Diseases

1.	Chronic Kidney Failure (Chronic Renal Failure)
2.	Delayed Emergence from Anesthesia
3.	Pain (Aches)
4.	Respiratory Insufficiency (Respiratory Failure)
5.	Airway Obstruction (Choking)

Experts

1.	Brull, Sorin J: 7 articles (03/2024 - 07/2010)
2.	Eikermann, Matthias: 7 articles (01/2020 - 03/2006)
3.	Ledowski, Thomas: 5 articles (01/2021 - 01/2013)
4.	Cammu, G: 5 articles (11/2018 - 02/2002)
5.	Martin-Flores, Manuel: 4 articles (05/2023 - 07/2012)
6.	Murphy, Glenn S: 4 articles (01/2021 - 05/2003)
7.	Kopman, Aaron F: 4 articles (01/2019 - 01/2004)
8.	Naguib, Mohamed: 4 articles (01/2019 - 03/2007)
9.	Carron, Michele: 4 articles (01/2018 - 08/2012)
10.	Blobner, Manfred: 4 articles (11/2010 - 03/2006)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Delayed Emergence from Anesthesia:

1.	SugammadexIBA 11/01/2015 - "After abdominal surgery, sugammadex reversal eliminated residual neuromuscular blockade in the PACU, and shortened the time from start of study medication administration to the time the patient was ready for discharge from the operating room. " 01/01/2023 - "Although sugammadex is well known for its use in reducing the incidence of residual neuromuscular blockade, this has not always been translated to improved clinical measures of postoperative respiratory muscle strength. " 01/01/2022 - "Our study showed that there was a 200% increase in the MEP amplitude in the first dorsal interosseous muscle at 3 min following reversal of residual neuromuscular blockade with sugammadex. " 11/01/2015 - "Effects of sugammadex on incidence of postoperative residual neuromuscular blockade: a randomized, controlled study." 05/10/2024 - "We have highlighted the importance of objective neuromuscular monitoring to guide sugammadex dosing and evaluation for residual neuromuscular blockade. "
2.	Neostigmine (Neostigmine Bromide)IBA 01/07/2023 - "In this trial, we aimed to evaluate the incidence of residual neuromuscular blockade (rNMB) in pediatric patients with routine use of neostigmine after recovery of spontaneous breathing compared with the patients with the use of neostigmine guided by neuromuscular monitoring. " 01/01/2018 - "In patients with a shallow residual block (T1 ≥ 25%) the mean neostigmine dose was 40 μg kg (13 trials, 535 patients), and the mean reversal time was 8.0 min (95% CI [6.8 to 9.2]). " 01/01/2018 - "In patients with moderate residual block (T1 10% to <25%) the mean neostigmine dose was 56 μg kg (seven trials, 342 patients), and the mean reversal time was 11.3 min (95% CI [9.2 to 13.4]). " 01/01/2018 - "In patients with deep residual block [T1 (first twitch height) <10%] 70 μg kg neostigmine was used (five trials, 118 patients), and the mean reversal time was 17.1 min (95% confidence interval (CI) [12.4 to 21.8]). " 04/12/2024 - "Time to extubation (time from neostigmine administration to extubation), time from neostigmine administration to TOF ratio (TOFr) 0.9 (neuromuscular recovery), and the incidence of residual neuromuscular blockade (RNMB) and other adverse effects were recorded. "
3.	Vecuronium Bromide (Vecuronium)FDA LinkGeneric 05/01/2014 - "Significant residual neuromuscular block could be measured at the hind limb with acceleromyography when ventilation had spontaneously returned to pre-vecuronium values. " 03/01/2014 - "[Extubation failure due to prolonged residual block after vecuronium. " 08/01/2001 - "Unmasked residual neuromuscular block after administration of vecuronium for days." 04/01/2000 - "Residual neuromuscular block caused by vecuronium alters pharyngeal function and impairs airway protection. " 03/01/2000 - "We conclude that it is necessary to antagonize residual block produced by vecuronium."
4.	Neuromuscular Blocking AgentsIBA 02/08/2024 - "Long-acting neuromuscular blocks followed by rapid reversal may provide prolonged surgeries with improved conditions by omitting repetitive or continuous administration of the neuromuscular blocking agent (NMBA), eliminating residual neuromuscular block and minimizing postoperative recovery, which, however, is not clinically available. " 04/15/2020 - "Incidence of residual neuromuscular blockade and use of neuromuscular blocking agents with or without antagonists: A systematic review and meta-analysis of randomized controlled trials." 09/01/2015 - "The objective of this study was to evaluate how Brazilian anesthesiologists are using neuromuscular blockers (NMB), focusing on how they establish the diagnosis of postoperative residual curarization and the incidence of complications associated with the use of NMB. " 09/01/2015 - "The objective of this study was to evaluate how Brazilian anesthesiologists are using neuromuscular blockers, focusing on how they establish the diagnosis of postoperative residual curarization and the incidence of complications associated with the use of neuromuscular blockers. " 03/01/2010 - "Many recent studies have underlined the importance of quantitative neuromuscular monitoring and the high incidence of residual block in clinical practice in spite of the use of nondepolarizing neuromuscular blockers of intermediate duration. "
5.	Rocuronium (Zemuron)FDA LinkGeneric 12/01/2011 - "In the present study we hypothesized that stapedius reflex measurement allows the detection of residual neuromuscular blockade using the stapedius muscle following the administration of rocuronium. " 01/01/2020 - "The hypoxic ventilatory response was reduced by 32% (p = 0.016) during residual neuromuscular block (rocuronium to train-of-four ratio 0.7), but the hypercapnic ventilatory response was unaffected. " 04/01/2013 - "We assessed the incidence of postoperative residual curarisation (PORC) after general anaesthesia with rocuronium in elderly and young patients, and we evaluated possible complications of postoperative residual curarisation. " 01/01/2007 - "We conclude that it is necessary to antagonize residual block after rocuronium, especially in the absence of perioperative neuromuscular monitoring." 01/01/2007 - "[The incidence of postoperative residual curarization in the recovery room after rocuronium administration]."
6.	Anesthetics (Anesthetic Agents)IBA 01/01/2023 - "This anesthetic combination may be beneficial in reducing doses of each anesthetic and avoiding delayed recovery from anesthesia, although further study is needed to confirm this." 01/01/2023 - "Absence of postoperative residual neuromuscular block is widely considered an anesthetic patient safety mandate. " 01/01/2021 - "Residual neuromuscular blockade and late neuromuscular blockade at the post-anesthetic recovery unit: prospective cohort study." 01/01/2020 - "But more plausible consequences of using soluble volatile anesthetics are delayed emergence from anesthesia and prolonged stays in the postanesthesia care unit (PACU). " 01/01/2016 - "Evidences demonstrate that postoperative residual neuromuscular blockade (rNMB) is a primary and frequent anesthetic risk factor for postoperative complications. "
7.	Glycopyrrolate (Glycopyrronium Bromide)FDA LinkGeneric 01/01/2024 - "Reversal of residual neuromuscular blockade was done with IV neostigmine and glycopyrrolate. " 07/01/2010 - "They developed NCPE within 3-5 minutes after administration of 'neostigmine-glycopyrrolate' used to reverse residual neuromuscular blockade. " 03/01/2000 - "Residual neuromuscular blockade was reversed using glycopyrronium and neostigmine at the end of surgery. " 09/01/1999 - "After surgery, residual neuromuscular blockade was reversed with neostigmine 2.5 mg i.v. and glycopyrrolate 0.5 mg i.v. only if clinically deemed necessary (i.e., fade on train-of-four stimulation, inadequate tidal volume, reduced hand grip, or inability to maintain head lift). " 04/01/1999 - "All patients received neostigmine and glycopyrrolate to reverse residual neuromuscular blockade. "
8.	Pyridostigmine Bromide (Pyridostigmine)FDA LinkGeneric 04/01/2019 - "Residual neuromuscular blockade was reversed with pyridostigmine and her muscle power completely recovered. " 12/01/2002 - "Without monitoring, the significant residual neuromuscular block after vecuronium or rocuronium is not eliminated even by reversal with a large dose of pyridostigmine and can still be a problem in the recovery room." 12/01/2002 - "We conclude that significant residual neuromuscular block after vecuronium or rocuronium was not eliminated even with reversal by a large dose of pyridostigmine. " 12/01/2002 - "We investigated postoperative residual curarization after administration of either vecuronium or rocuronium with reversal by pyridostigmine in 602 consecutive patients without perioperative neuromuscular monitoring. " 12/01/2002 - "The patients with residual block had several associated factors: the absence of perioperative neuromuscular monitoring, the use of pyridostigmine, which is less potent than neostigmine, a larger dose of vecuronium, shorter time from the last neuromuscular blocker to TOF monitoring, or peripheral cooling. "
9.	Flumazenil (Romazicon)FDA LinkGeneric 04/01/2013 - "From experience of this case, administration of flumazenil may be beneficial for improvement in consciousness in cases with unexpectedly delayed emergence from anesthesia." 12/01/2010 - "The administration of naloxone hydrochloride and flumazenil failed to improve delayed recovery from anesthesia. "
10.	Propofol (Diprivan)FDA LinkGeneric 02/01/2001 - "Although the clearance of propofol was high (2.8 l.min-1) because of the thyrotoxic state, the patient showed delayed recovery from anesthesia. "

Therapies and Procedures

1.	Anesthesia 10/06/2017 - "The aim of the study is to assess the effect of a neuromuscular monitoring e-learning module on anesthesia staff's use of objective neuromuscular monitoring and the incidence of residual neuromuscular blockade in surgical patients at 6 Danish teaching hospitals. " 07/01/2013 - "Over the past three decades, many studies have shown a high proportion of patients in the recovery room with residual neuromuscular blockade after anesthesia. " 04/01/2013 - "The purpose of this study was to access the incidence of residual neuromuscular block in a post-anesthesia care unit and to evaluate its association with critical respiratory events. " 03/01/1991 - "The present study employed train-of-four (TOF) stimulation at a current of 20 mA to assess the incidence and degree of residual neuromuscular blockade in 64 randomly selected Post Anesthesia Care Unit (PACU) patients. " 12/01/2023 - "However, residual neuromuscular blockade (RNMB) can lead to respiratory complications in post-anesthesia care units (PACUs). "
2.	General Anesthesia 01/01/2019 - "Grip strength can be used to evaluate postoperative residual neuromuscular block recovery in patients undergoing general anesthesia." 01/01/2016 - "Incidence of postoperative residual neuromuscular blockade after general anesthesia: a prospective, multicenter, anesthetist-blind, observational study." 01/01/2023 - "Neuromuscular muscle relaxants are still indispensable for surgical procedures requiring general anesthesia, and the use of these agents may result in postoperative residual curarization. " 01/01/2022 - "Residual neuromuscular blockade (RNMB) is a frequent event after general anesthesia, which can lead to serious complications, such as upper airway obstruction. " 01/01/2016 - "Residual neuromuscular block (NMB) after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD). "
3.	Operative Surgical Procedures 11/01/2014 - "Because of increased outpatient surgical procedures postoperative residual curarization and rapid postoperative recovery have a greater importance in the pediatric patient population. " 05/01/2011 - "Residual neuromuscular blockade continues to be a clinical problem after surgical procedures. " 05/01/2003 - "Residual neuromuscular blockade remains a problem even after short surgical procedures. " 01/01/2023 - "Neuromuscular muscle relaxants are still indispensable for surgical procedures requiring general anesthesia, and the use of these agents may result in postoperative residual curarization. " 04/26/2024 - "Age-related differences in the pharmacokinetics and pharmacodynamics of neuromuscular blocking agents (NMBAs) and the short duration of many surgical procedures put pediatric patients at risk of postoperative residual curarization (PORC). "
4.	Therapeutics 02/01/1998 - "Because the patient was responding to therapy, plasmaphoresis was used to reduce the level of HAMA followed by unlabeled Lym-1 calculated to be sufficient to block residual HAMA. " 12/01/2021 - "Initially, delayed emergence from anesthesia was suspected, but the electroencephalogram confirmed NCSE, and anticonvulsant therapy was initiated. " 12/01/2016 - "Sugammadex as rescue therapy for residual neuromuscular blockade in the intensive care unit." 12/01/2020 - "A novel deep-learning-based model was developed from a cohort of 424 patients with HBV-related cirrhosis on entecavir therapy with 2 residual blocks, including 7 layers of a neural network, and it was validated using an independent external cohort (n = 316). " 01/01/2020 - "Most postoperative surgical patients routinely receive supplemental oxygen therapy to prevent the potential development of hypoxemia due to incomplete lung re-expansion, reduced chest wall, and diaphragmatic activity caused by surgical site pain, consequences of hemodynamic impairment, and residual effects of anesthetic drugs (most notably residual neuromuscular blockade), which may result in atelectasis, ventilation-perfusion mismatch, alveolar hypoventilation, and impaired upper airway patency. "
5.	Length of Stay 04/01/2024 - "Postoperative residual curarisation increased length of hospital stay and respiratory complications." 12/01/2023 - "Delayed emergence from anesthesia and high postoperative sedation are associated with a prolonged length of stay in the operating room and the postanesthesia care unit (PACU), which increases health care costs. " 01/01/2019 - "Further, we found a trend toward increased hospital length of stay in patients with postoperative residual neuromuscular blockade (adjusted incidence rate ratio, 1.09; P = .06). " 01/01/2019 - "We conducted a retrospective cohort study to investigate the effects of postoperative residual neuromuscular blockade on hospital costs (primary outcome), intensive care unit admission rate, and hospital length of stay (secondary outcomes). " 02/21/2018 - "Postoperative residual curarization is a topic of paramount importance, because its occurrence can cause complications and increase the length of stay in hospital and the related costs. "