- 86 Downloads
An event is serious (based on the ICH definition) when the patient outcome is:
* congenital anomaly
* other medically important event
In an observational study, two patients were described, of whom a 70‑year‑old woman experienced delayed recovery from anaesthesia following administration of propofol, fentanyl, atracurium besilate [atracurium], dexmedetomidine and desflurane, and a 70-year-old man experienced delayed recovery from anaesthesia following administration of propofol, fentanyl, atracurium besilate, sevoflurane and levobupivacaine used as an anaesthetic agents [not all routes, dosages and time to reactions onset not stated].
Case 1: A 70‑year‑old woman, who had carcinoma endometrial, was scheduled for a robotic hysterectomy. Pulmonary function tests showed small airway obstruction. The volume controlled mode was used for ventilation during operation. During the surgery, anaesthesia was maintained with dexmedetomidine and desflurane titrated to a minimum alveolar concentration of 1 to 1.2 via an 8mm internal diameter endotracheal tube. Standard monitoring and a uniform plan of induction with fentanyl, propofol and atracurium besilate were followed. The surgery lasted 6 hours with a console time of 3 hours. Pelvic lymphadenopathy was not performed due to gross fatty deposition in the pelvis. Blood gases analysis performed after undocking revealed normal values of oxygenation, pH, and normocarbia. Considering the short console time, lesser than planned extent of operation and high chances of pulmonary complications with prolonged ventilation, tracheal extubation was planned. However, as she was not conscious even 1 hour after reversal of neuromuscular blockade (delayed recovery from anaesthesia) and return of acceptable spontaneous minute volumes, she had to be ventilated postoperatively. The optic nerve sheath diameter at this time point was increased at 5.1cm. After 12 hours of elective ventilation, she was extubated.
Case 3: A 70-year-old man, who had rectum carcinoma, was scheduled for robotic abdominoperineal resection. He had a baseline optic nerve sheath diameter of 3.4cm. His lungs were ventilated on the volume controlled mode via a 7.5mm internal diameter endotracheal tube. Sevoflurane was titrated to a minimum alveolar concentration of 1 to 1.2. Intravenous fentanyl and atracurium besilate, and epidural levobupivacaine were also administered. Standard monitoring and a uniform plan of induction with propofol was followed. His surgery lasted for 11.5 hours. The console time was 8 hours with a 10 minutes period of abdominal desufflation after 6 hours of docking. The optic nerve sheath diameter examined 30 minutes post undocking was 5.4cm. He had a delayed recovery from anaesthesia. Hence, elective ventilation was decided. After 10 hours of overnight ventilation, he was uneventfully extubated.
Author comment: "However, as the patient was not conscious even 1 h after reversal of neuromuscular blockade and return of acceptable spontaneous minute volumes, she had to be ventilated postoperatively." "Our third patient had the longest operating time of 11.5 h. As the [optic nerve sheath diameter] measured after undocking was high at 5.4 cm, we electively ventilated him postoperatively." "Recovery from anaesthesia can be delayed in such patients".
- Sujata N, et al. Optic nerve sheath diameter-guided extubation plan in obese patients undergoing robotic pelvic surgery in steep Trendelenburg position: A report of three cases. Indian Journal of Anaesthesia 62: 896-899, No. 11, Nov 2018. Available from: URL: http://doi.org/10.4103/ija.IJA_370_18 -IndiaCrossRefGoogle Scholar