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Delayed Recovery in trauma
patients
By:
Aya Hisham Moussa
Assistant Lecturer of Anesthesia & Intensive Care
Under Supervision of:
Dr. Rania Hassan
Lecturer of Anesthesia & Intensive Care
Definition
•failure of patient to regain expected
level of consciousness within 30
minutes of the end of anesthetic
administration.
Causes
Multifactorial : recovery may be delayed due
to
•Anaesthesia related factors
•Surgery related factors
•Patient related factors
Anaesthesia related factors
•Pharmacological factors
•Non pharmacological factors
Pharmacological factors
•Inadvertent administration of an inappropriate dose
of an anaesthetic agent which is inappropriate for
 the size/age/condition of the patient or
 the duration of surgery
•Increased sensitivity to normal dosage
•Decreased metabolism/excretion & active
metabolites
•Co-adminiteration of synergistic drugs
Non pharmacological factors
•Hypothermia
•Hypotension
•Hypoxia/hypercapnia
•Fluid overload
•Equipment malfunction- hypoxic mixtures,
overdosing with inhalational A. agents
Patient related factors
•Age
•Hereditary/genetic factors: polymorphisms
•Co-morbidities
•Endocrine/metabolic factors
•Preoperative medications
•Addictions - alcohol, drugs
Surgery related factors
•Prolonged surgical time
•Type of surgical procedure
Special Considerations
Regarding Trauma Patients
Pharmacology with Hypovolemia
and depressed COP
•In case of hypovolemia...
•How the CNS is affected...
•How the NMJ is affected...
•Anesthetic considerations in pt. with acidosis....
•Hypothermia & inhaled agents' MAC ...
Trauma Triad of Death
"The bloody vicious cycle"
Effects of acidosis
•Metabolic acidosis induces widespread
system dysfunction.
•CNS effects
•Cardiovascular system
•Respiratory system
Management of Acidosis
•Fluid resuscitation remains the mainstay
of therapy before and after source
control in trauma.
•The objective of resuscitation is to
restore homeostasis and maintain tissue
perfusion.
•Sodium Bicarbonte is indicated in …
Hypothermia
•Definition
Traditional classification of hypothermia
and revised definitions for the trauma patient
Management of Different Levels of
Hypothermia in Trauma Victims
Rewarming Methods in Trauma Victims
A stepwise approach to patient with delayed
recovery
Sinclair R C F , and Faleiro R J Contin Educ Anaesth Crit Care Pain 2006;6:114-
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