Pre-existing Factors Affecting Recovery
A relative overdose of depressant drugs relative to the patient’s age and weight is one of many causes of a delayed return of consciousness (p. 93). This is particularly true when large doses of narcotic analgesic agents are given to the frail and elderly, but relative overdose may also follow benzodiazepine, phenothiazine or hyoscine (scopolamine) administration. Reversal of the effects of opiates can be achieved by intravenous naloxone (0.1–0.4 mg) or doxapram (50–100 mg).
Benzodiazepines can be reversed by the recently introduced specific antagonist flumazenil. Like naloxone, it should be administered slowly until the desired effect is obtained. The usual dose is 300–600 µg.
Long-acting premedicating agents whose action may persist into the postoperative period, especially if the surgical procedure is brief. Examples include droperidol and lorazepam.
Anti-sialogogues. When anti-sialogogues have been omitted, recovery may be accompanied by excessive salivation, especially following intubation, oral surgery and certain premedications e.g. lorazepam. Frequent suction may be necessary to maintain a clear airway and to prevent coughing and laryngeal irritation.
KeywordsHydrocortisone Respiration Morphine Warfarin Hypothyroidism
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- Aldrete JA, Guerra F (1981) Hematological disease. In: Katz J, Benumof J, Kadis LB (eds) Anaesthesia and uncommon diseases, WB Saunders, Philadelphia, pp. 313–383Google Scholar
- Bevan DR (1979) Renal function in anaesthesia and surgery. Academic Press, LondonGoogle Scholar
- Caldwell TB (1981) Anaesthesia for patients with behavioral and environmental disorders. In: Katz J, Benumof J, Kadis LB (eds) Anaesthesia and uncommon diseases. WB Saunders, Philadelphia pp 672–777Google Scholar
- Chung DC (1982) Anaesthesia in patients with ischaemic heart disease. Edward Arnold, London Davenport H ( 1986 ) Anaesthesia in the elderly. Heinemann Medical Books, LondonGoogle Scholar
- Gareth J (1982) Symposium on anaesthesia and respiratory function. Br J Anaesth 54: 701–782Google Scholar
- Gothard JWW (1987) Anaesthesia for cardiac surgery and allied procedures. Blackwell Scientific Publications, OxfordGoogle Scholar
- Prys-Roberts CPR (1980) The circulation in anaesthesia. Blackwell Scientific Publications, Oxford Strunin L ( 1977 ) The liver and anaesthesia. Butterworths, LondonGoogle Scholar
- Sykes MK, McNicol MW, Campbell EJM (1976) Respiratory failure. Blackwell Scientific Publications, OxfordGoogle Scholar
- Taylor TH, Major E (1987) Hazards and complications of anaesthesia. Churchill Livingstone, LondonGoogle Scholar
- Vickers MD (1982) Medicine for anaesthetists. Blackwell Scientific Publications, OxfordGoogle Scholar
- Vickers MD, Wood-Smith FG, Stewart HC (1978) Drugs in anaesthetic practice. Butterworths, LondonGoogle Scholar
- Watkins J Salo M (1982) Trauma, stress and immunity in anaesthesia and surgery. Butterworth Scientific, LondonGoogle Scholar