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Failure to awaken from general anesthesia due to infratentorial hemorrhage after cervical spine surgery: A case report.

Authors
  • Kim, Ji Hyun
  • Jin, Yehun
  • Hong, Seong Wook
Type
Published Article
Journal
Medicine
Publisher
Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins
Publication Date
Nov 01, 2019
Volume
98
Issue
44
Identifiers
DOI: 10.1097/MD.0000000000017678
PMID: 31689785
Source
Medline
Language
English
License
Unknown

Abstract

Emergence is not simply the reverse process of induction. Many dynamic situations could occur in this period by distinct neurobiology as recent studies indicated. Herein we report a rare case of failure of emergence from general anesthesia after cervical spine surgery. Despite the perioperative vital signs and laboratory results were unremarkable, the patient could not recover his mental status and spontaneous breathing during emergence. 20 minutes after cessation of anesthetic drug administration, his blood pressure suddenly began to decrease requiring transfusion and vasopressor. After thorough inspection of intraoperative alterations of hemodynamic and metabolic values, which showed no significant changes except possible signs of delayed volume loss, cerebrovascular bleeding was most suspected as the cause of the event. Computed tomography was performed and infratentorial hemorrhage after cervical spine surgery was checked. Decompression operation was required for removing the hemorrhage. However, the patient's family refused further management considering his limited life expectancy. The patient expired on postoperative day 5. Failure to awaken is a relatively rare event. It could be confused with simple delayed emergence, which is often caused by residual drug effect. However, when it occurs, the result could be devastating. Therefore, appropriate recognition and prompt response are required to decrease the mortality and morbidity of the patient.

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