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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- Thank you