Adults

Delayed Emergence

Diagnosis

Prolonged unresponsiveness following general anesthesia or abnormal neurologic exam following general anesthesia

Diagnosis

Prolonged unresponsiveness following general anesthesia or abnormal neurologic exam following general anesthesia

  1. Call for help

    • Ask: "Who will be the crisis manager?"
    • Crisis manager designates checklist reader

  2. Ensure all anesthetic medications have been stopped

  3. Check for and correct hypoxemia, hypercarbia, hypothermia, or hypotension

    • Consider signs of increased intracranial pressure (widened pulse pressure, bradycardia, irregular respirations)

  4. Check for and treat residual drug effects

    • Neuromuscular blockade (check TOF)
    • Opiates and hypnotics

  5. Send labs

    • Arterial blood gas, electrolytes, glucose

  6. Correct electrolyte, glucose abnormalities

  7. Perform neurologic examination

    • If unresponsive: pupil changes, gag reflex, level of arousal
    • If responsive: stroke assessment
      • Facial droop - show teeth in smile
      • Pronator drift - eyes closed, extend arms with palms up for 10 seconds
      • Speech assessment - say “you can’t teach old dogs new tricks”
      • Assess for severe sudden headache
    • Consider STAT head CT and neurology consult for abnormal exam

Patient weight

Between 30 kg and 250 kg

Reset the checklist?

Checked steps, the timer and this crisis log are cleared. The patient’s weight is kept.

Finish the crisis?

The timer pauses, and you can review the case and the event log.