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Anesthesia

Failure to wake up after anesthesia

09/08/2006

Question:

What is the name of the disorder that causes a patient to not wake up from anesthesia?

Answer:

There are several possible causes for delayed "emergence" - the technical term for waking up - but no specific, single disorder that would cause a patient not to wake up at all after anesthesia. The failure to wake up would be called coma, and in fact general anesthesia is nothing other than a highly controlled form of chemically-induced coma.

Any severe disruption of the supply of oxygen-carrying blood to the brain can damage it permanently. The oxygen-deprived brain cannot survive intact for more than 5 or 6 minutes. There are a variety of anesthetic and surgical "disasters" that can produce this result, for example major bleeding. Fortunately this outcome is rare.

The brain also needs fuel - particularly glucose - so a very low glucose level can delay emergence or even cause permanent coma. There are disorders in which the brain is injured - such as strokes, or bleeding into the brain. The brain also needs to have normal chemistry, such as a normal level of sodium in the blood, in order to function normally.

Delayed emergence can of course be a result of delay in getting rid of anesthetic or sedative drugs. This can happen when large doses are given, in the elderly, and in those with liver or kidney function that is not normal and the drugs cannot be metabolized or excreted. A low body temperature, whether deliberately induced, or occurring accidentally, can slow emergence a lot. I hope this gives you an idea of the possible causes of a fortunately very rare occurrence.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University