Local and Regional Anesthesia最新文献

{"title":"The Current Practice of Spinal Anesthesia in Anesthetists at a Comprehensive Specialized Hospital: A Single Center Observational Study.","authors":"Metages Hunie,&nbsp;Efrem Fenta,&nbsp;Simegnew Kibret,&nbsp;Diriba Teshome","doi":"10.2147/LRA.S300054","DOIUrl":"https://doi.org/10.2147/LRA.S300054","url":null,"abstract":"<p><strong>Background: </strong>Spinal anesthesia block is the most widely practiced anesthesia technique due to its safety margin. It is an invasive procedure that could be associated with a variety of complications like total spinal, cardiovascular collapse, meningitis, paralysis, and even death. The aim of this study to assess the current practice of spinal anesthesia.</p><p><strong>Methods: </strong>A Cross-sectional study design was conducted in Debre Tabor Comprehensive Specialized Hospital from November 01 to December 15, 2020. All anesthesia professionals who are working in the study Hospital were surveyed by the Purposive sampling technique. A standardized structured checklist prepared from recommendations of New York school of regional anesthesia guideline regarding the current Practice of spinal anesthesia was used to collect the data after taking written informed consent. Descriptive statistics were employed to summarize the results.</p><p><strong>Results: </strong>A total of 24 anesthetists were observed of their practice before, during, and after administer of spinal anesthesia. All of the anesthetists were practicing the preparation and assembling of all necessary anesthesia equipments, resuscitation drugs, and basic monitors while all of the anesthetists did not wash their hands, wore a sterile gown, and draped the back of the patient with fenestrated drapes in a sterile fashion.</p><p><strong>Conclusion: </strong>Most of the anesthesiology professionals in our setting have a good preparation of all necessary anesthesia equipments, and resuscitation drugs, while the assessment of patient's emotional reaction and pain during injection, the skin preparation allowed to being dry and assessment of the degree of sensory and motor block of the patient were insufficient.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"14 ","pages":"51-56"},"PeriodicalIF":2.9,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b0/e4/lra-14-51.PMC8020134.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25572874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Levobupivacaine Consumption in Automated Intermittent Bolus in Ultrasound Guided Subparaneural Sciatic Nerve Catheters: A Prospective Double-Blind Randomized Trial.","authors":"Margaretha B Breebaart,&nbsp;Jordi Branders,&nbsp;Luc Sermeus,&nbsp;Sultan Termurziev,&nbsp;Helene Camerlynck,&nbsp;Lennert Van Putte,&nbsp;Marnik Van Putte Minelli,&nbsp;Stefan De Hert","doi":"10.2147/LRA.S299870","DOIUrl":"https://doi.org/10.2147/LRA.S299870","url":null,"abstract":"<p><strong>Purpose: </strong>Continuous sciatic nerve blocks have proven benefits for postoperative analgesia after foot surgery. However, the optimal mode of administration remains a point of debate. Ultrasound guided subparaneural injection accelerates onset time and increases duration after a single shot sciatic nerve block. This double blind prospective randomized trial compares the 48-hour local anesthetic (LA) dose consumption of an automated intermittent bolus technique to a continuous infusion regimen in a subparaneural sciatic nerve catheter after hallux valgus surgery.</p><p><strong>Patients and methods: </strong>Patients scheduled for hallux valgus surgery were randomized to receive either a continuous infusion of levobupivacaine 0.125% at 5mL/h (group A) or an intermittent automated bolus of 9.8 mL every 2 hours with a background of 0.1 mL/h (group B), both with a PCA bolus of 6 mL and lockout of 30 minutes. The 48 hour LA consumption, PCA boluses, Numeric Rating Scale (NRS), satisfaction and return of normal sensation were recorded.</p><p><strong>Results: </strong>Sixteen patients were excluded because of protocol violation or technical problems and 42 patients remained for analysis. The 48 hour ropivacaine consumption was higher in group A (293 ±60 mL) than group B (257±33 mL). The median and highest NRS scores and patient satisfaction were not statistically different between groups. Normal sensation returned after 75 ± 22 hours (group A) and 70 ± 17 hours (group B).</p><p><strong>Conclusion: </strong>Programmed bolus administration in subparaneural sciatic nerve catheters reduces LA consumption 48 hours after surgery with equal analgesia and patient satisfaction. Return of sensation is variable and can last more than 75 hours.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"14 ","pages":"43-50"},"PeriodicalIF":2.9,"publicationDate":"2021-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0a/93/lra-14-43.PMC8007557.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25535734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypotension Associated with MTS is Aggravated by Early Activation of TEA During Open Esophagectomy.","authors":"Rune B Strandby,&nbsp;Rikard Ambrus,&nbsp;Linea L Ring,&nbsp;Nikolaj Nerup,&nbsp;Niels H Secher,&nbsp;Jens P Goetze,&nbsp;Michael P Achiam,&nbsp;Lars B Svendsen","doi":"10.2147/LRA.S294556","DOIUrl":"https://doi.org/10.2147/LRA.S294556","url":null,"abstract":"<p><strong>Objective: </strong>A mesenteric traction syndrome (MTS) is elicited by prostacyclin (PGI₂)-induced vasodilation and identified by facial flushing, tachycardia, and hypotension during abdominal surgery. We evaluated whether thoracic epidural anesthesia (TEA) influences the incidence of MTS.</p><p><strong>Design: </strong>Randomized, blinded controlled trial.</p><p><strong>Setting: </strong>Single-center university hospital.</p><p><strong>Participants: </strong>Fifty patients undergoing open esophagectomy.</p><p><strong>Interventions: </strong>Patients were randomized to either early (EA, after induction of general anesthesia) or late activation of TEA (LA, after re-established gastric continuity). Plasma 6-keto-PGF_1α, a stable metabolite of PGI₂ and interleukine-6 (IL6) were measured in plasma during surgery along with hemodynamic variables and MTS graded according to facial flushing together with plasma C-reactive protein on the third post-operative day.</p><p><strong>Results: </strong>Forty-five patients met the inclusion criteria. Development of MTS tended to be more prevalent with EA (n=13/25 [52%]) than with LA TEA (n=5/20 [25%], p=0.08). For patients who developed MTS, there was a transient increase in plasma 6-keto-PGF_1α by 15 min of surgery and plasma IL6 (p<0.001) as C-reactive protein (P<0.009) increased. EA TEA influenced the amount of phenylephrine needed to maintain mean arterial pressure >60 mmHg in patients who developed MTS (0.16 [0.016-0.019] mg/min vs MTS and LA TEA 0.000 [0.000-0.005] mg/min, p<0.001).</p><p><strong>Conclusion: </strong>The incidence of MTS is not prevented by TEA in patients undergoing open esophagectomy. On the contrary, the risk of hypotension is increased in patients exposed to TEA during surgery, and the results suggest that it is advantageous to delay activation of TEA. Also, MTS seems to be associated with a systemic inflammatory response, maybe explaining the aggravated post-operative outcome.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"14 ","pages":"33-42"},"PeriodicalIF":2.9,"publicationDate":"2021-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cc/4c/lra-14-33.PMC7936689.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25451428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of Morphological and Morphometrical Variations of Sacral Hiatus in Dry Human Sacrum in Ethiopia.","authors":"Zerihun Abera,&nbsp;Amanuel Girma,&nbsp;Assegedech Bekele,&nbsp;Mohammed Oumer","doi":"10.2147/LRA.S277556","DOIUrl":"https://doi.org/10.2147/LRA.S277556","url":null,"abstract":"<p><strong>Background: </strong>The sacral hiatus is an opening present at the lower end of the sacral canal. The anatomy of the sacral hiatus and its variations are clinically important during administration of caudal epidural block (CEB) in obstetrics and gynecology, orthopedic, urology and general surgical practices. The success and reliability of CEB depends upon the sound knowledge of anatomical variations of the sacral hiatus.</p><p><strong>Objective: </strong>The aim of this study was to assess the morphological and morphometric variation of the sacral hiatus in dry human sacrum.</p><p><strong>Methods: </strong>An institution-based observational cross-sectional study design was conducted to assess morphological and morphometric variations of the sacral hiatus in 61 dry human sacrum specimens at the anatomy departments of Gondar, Addis Ababa, Hawassa and Jimma universities and Hayat and Korea Medical Colleges in Addis Ababa. Descriptive analysis was applied to analyze the data.</p><p><strong>Results: </strong>The most commonly recorded shape of the sacral hiatus is inverted-V (41%) followed by inverted-U (37.7%). The least common was complete bifida (1.6%). The apex of the sacral hiatus is mostly seen at the level of the 4th sacral vertebra (60.7%), while the base is commonly located at the level of the 5th sacral vertebra (78.7%). The mean length of the sacral hiatus is 22.67 ± 11.84 mm. The mean transverse width and mean anteroposterior diameter of the sacral hiatus at the apex are 13.14 mm ± 2.85 mm and 5.57 mm ± 1.53 mm, respectively.</p><p><strong>Conclusion: </strong>The sacral hiatus has anatomical variations. These variations should be kept in mind during administration of caudal epidural anesthesia and analgesia.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"14 ","pages":"25-32"},"PeriodicalIF":2.9,"publicationDate":"2021-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fb/29/lra-14-25.PMC7917331.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25427136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Labor Epidural in a Patient Who is Allergic to Lidocaine: A Case Series.","authors":"Akshatha Kamath,&nbsp;Vikas Raghove,&nbsp;Allison Kalstein,&nbsp;Joel Yarmush","doi":"10.2147/LRA.S253087","DOIUrl":"https://doi.org/10.2147/LRA.S253087","url":null,"abstract":"<p><p>Continuous epidural anesthesia is considered the best modality for pain relief during labor, local anesthetic allergy is an uncommon occurrence but if a patient has an allergy to bupivacaine or lidocaine owing to its cross-reactivity with bupivacaine then it becomes very challenging to manage labor analgesia. A direct challenge test to rule out actual hypersensitivity was not considered a viable option given the risks involved if a severe allergic reaction occurred with the test dose. Using IV opioid-based analgesia has harmful effects for both mother and the baby in addition to decreasing participation of mothers in the birthing process owing to its sedative properties. We report two cases where the mother had a history of lidocaine allergy, so labor analgesia was managed using chloroprocaine patient-controlled epidural analgesia (PCEA).</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"14 ","pages":"21-23"},"PeriodicalIF":2.9,"publicationDate":"2021-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6f/cc/lra-14-21.PMC7896772.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25398740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Observer-Blinded Controlled Trial to Compare Pre-Emptive with Postoperative Ultrasound-Guided Mandibular Nerve Block for Postoperative Analgesia in Mandibular Fracture Surgeries.","authors":"Rajagopalan Venkatraman,&nbsp;Kandhan Karthik,&nbsp;Cherian Belinda,&nbsp;Ramamurthy Balaji","doi":"10.2147/LRA.S290462","DOIUrl":"https://doi.org/10.2147/LRA.S290462","url":null,"abstract":"<p><strong>Background and aims: </strong>Ultrasound-guided (UG) mandibular nerve block is effective for providing postoperative analgesia in mandibular fracture surgeries. The pre-emptive nerve blockade prolongs the duration of postoperative analgesia and reduces the consumption of intraoperative opioids. The aim of this prospective, randomized, single-blinded study was to compare the efficacy of pre-emptive and postoperative UG mandibular nerve block for postoperative analgesia in mandibular fracture surgeries.</p><p><strong>Methods: </strong>Sixty patients scheduled for unilateral mandibular fracture surgeries were randomly divided into two groups by computer-generated random numbers and sealed envelope method: Group A received UG mandibular nerve block before surgical incision and group B received after surgery with ropivacaine 0.5% 10mL. The second anesthesiologist, who was blinded to the group involved, monitored the patient. The patients as well as the statistician were also blinded. The patients were started on patient-controlled analgesia (PCA) morphine with bolus 1mg and a lockout interval of 10min. The morphine consumption for 24h was recorded. The pain was assessed by the VAS score. The additional intraoperative fentanyl consumption and time for a request for rescue analgesic were recorded.</p><p><strong>Results: </strong>The total morphine consumption was reduced in group A (4.566±0.717mg) than group B (5.93±0.876mg) with a p-value of <0.0001. The time for a request for rescue analgesic was also prolonged in group A (794.08±89.561min) than group B (505.333±3.159min). In group A, only four patients required an additional dose of fentanyl as against 11 patients in group B. The heart rate was also lower in group A 30min after the administration of the block and persisted for two hours intraoperatively.</p><p><strong>Conclusion: </strong>Pre-emptive ultrasound-guided mandibular nerve block reduces morphine consumption, prolongs the time for a request for rescue analgesic, reduces intraoperative fentanyl consumption, provides better control of intraoperative heart rate, and better pain scores postoperatively when compared to the postoperative mandibular nerve block.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"14 ","pages":"13-20"},"PeriodicalIF":2.9,"publicationDate":"2021-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/62/91/lra-14-13.PMC7882799.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25381467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Anesthesia Using Ultra-Low-Dose Isobaric Bupivacaine with Intrathecal Morphine-Fentanyl for Bilateral Low Extremity Procedures in a Geriatric Patient with Recent Myocardial Infarction and Percutaneous Coronary Intervention.","authors":"Ambrose Rukewe,&nbsp;Linea Nanyalo-Nashima,&nbsp;Nicola Olivier","doi":"10.2147/LRA.S287975","DOIUrl":"https://doi.org/10.2147/LRA.S287975","url":null,"abstract":"<p><p>A recent inferior ST-elevation myocardial infarction and percutaneous coronary intervention in an elderly female patient scheduled for bilateral lower extremity operations simultaneously represent significant risks for re-infarction and mortality. Our index patient required an above-knee amputation of the left leg to prevent infection/progressing gangrene as well as application of a back-slab for the conservative management of a fractured right femur. We employed spinal injection of ultra-low-dose 0.5% isobaric bupivacaine 4 mg with morphine 75 mcg plus fentanyl 10 mcg which provided adequate anesthesia for radical amputation, effective postoperative analgesia and good hemodynamic stability.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"14 ","pages":"7-11"},"PeriodicalIF":2.9,"publicationDate":"2021-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5d/44/lra-14-7.PMC7837540.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25314493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomic Landmark Technique Thoracic Paravertebral Nerve Block as a Sole Anesthesia for Modified Radical Mastectomy in a Resource-Poor Setting: A Clinical Case Report.","authors":"Abebayehu Zemedkun,&nbsp;Belete Destaw,&nbsp;Mesay Milkias","doi":"10.2147/LRA.S291308","DOIUrl":"https://doi.org/10.2147/LRA.S291308","url":null,"abstract":"<p><p>Mastectomy is mostly performed as definitive management for resectable breast cancer. Implementing paravertebral nerve block for patients with metastasis features of cancer to lungs and other organs, patients with co-morbidity, geriatrics, and malnourished individuals will eliminate the risks and complications of general anesthesia. Though thoracic paravertebral block is an established technique as postoperative pain management for breast surgery, there is no conclusive evidence on its use as a sole anesthetic for modified radical mastectomy. In this case report, we present a 33-year-old woman who underwent a successful modified radical mastectomy for stage IIIb breast cancer associated with clinical and radiological features of metastasis to the lung under a multiple injection landmark technique paravertebral nerve block. We believe that the anatomic landmark technique paravertebral nerve block can be used as an alternative anesthetic technique for modified radical mastectomy in a resource-limited setting for patients who are expected to have a high risk of perioperative complications under general anesthesia.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"14 ","pages":"1-5"},"PeriodicalIF":2.9,"publicationDate":"2021-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7e/8a/lra-14-1.PMC7814229.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38853659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Different Doses of Intravenous Dexmedetomidine on the Properties of Subarachnoid Blockade: A Systematic Review and Meta-Analysis.","authors":"Mohammad K Al Nobani,&nbsp;Mohammed A Ayasa,&nbsp;Tarek A Tageldin,&nbsp;Abduljabbar Alhammoud,&nbsp;Marcus Daniel Lance","doi":"10.2147/LRA.S288726","DOIUrl":"https://doi.org/10.2147/LRA.S288726","url":null,"abstract":"<p><strong>Background: </strong>Dexmedetomidine is a sedative and analgesic medication which has gained an increased usage as an adjuvant to both general and regional anaesthesia in recent years. In this systematic review and meta-analysis, we examined the changes to the characteristics of subarachnoid block when accompanied with intravenous dexmedetomidine. Our aim is to evaluate the effects of different doses of intravenous dexmedetomidine on the sensory and motor blockade duration of a single shot spinal anaesthetic and the incidence of any associated side effects.</p><p><strong>Methods: </strong>We searched published randomized clinical trials (RCTs) from January 1992 to April 2019 that investigated the use of IV dexmedetomidine with spinal anaesthesia. After considering our inclusion and exclusion criteria, we included 15 RCTs with 985 patients. We analyzed the duration of sensory and motor blockade and the related adverse effects in relation to different doses of IV dexmedetomidine.</p><p><strong>Results: </strong>Intravenous dexmedetomidine, with loading dose of 1 mcg/kg, prolonged the sensory blockade duration of spinal anaesthesia by a mean difference of 49.6 min, P<0.001, and motor blockade duration by a mean difference of 44.7 min, P<0.001, while a loading dose of 0.5 mcg/kg prolonged the sensory blockade by a mean difference of 43.06 min, P<0.001, and motor blockade duration by a mean difference of 29.09 min, P<0.001. Dexmedetomidine-related side effects were higher in patients receiving larger doses; the incidence of bradycardia was higher (OR=3.53, P<0.001) and incidence of hypotension showed a 1.29 fold increase when compared to the control group (P=0.065).</p><p><strong>Conclusion: </strong>The administration of intravenous dexmedetomidine in conjunction with spinal anaesthesia can significantly prolong the duration of both sensory and motor blockade. The use of larger loading doses of dexmedetomidine was associated with a larger side-effect profile with minimal beneficial changes when compared to lower loading doses.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"207-215"},"PeriodicalIF":2.9,"publicationDate":"2020-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38763644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed Emergence from Anesthesia: What We Know and How We Act.","authors":"Marco Cascella,&nbsp;Sabrina Bimonte,&nbsp;Raffaela Di Napoli","doi":"10.2147/LRA.S230728","DOIUrl":"https://doi.org/10.2147/LRA.S230728","url":null,"abstract":"<p><p>The emergence from anesthesia is the stage of general anesthesia featuring the patient's progression from the unconsciousness status to wakefulness and restoration of consciousness. This complex process has precise neurobiology which differs from that of induction. Despite the medications commonly used in anesthesia allow recovery in a few minutes, a delay in waking up from anesthesia, called delayed emergence, may occur. This phenomenon is associated with delays in the operating room, and an overall increase in costs. Together with the emergence delirium, the phenomenon represents a manifestation of inadequate emergence. Nevertheless, in delayed emergence, the transition from unconsciousness to complete wakefulness usually occurs along a normal trajectory, although slowed down. On the other hand, this awakening trajectory could proceed abnormally, possibly culminating in the manifestation of emergence delirium. Clinically, delayed emergence often represents a challenge for clinicians who must make an accurate diagnosis of the underlying cause to quickly establish appropriate therapy. This paper aimed at presenting an update on the phenomenon, analyzing its causes. Diagnostic and therapeutic strategies are addressed. Finally, therapeutic perspectives on the \"active awakening\" are reported.</p>","PeriodicalId":18203,"journal":{"name":"Local and Regional Anesthesia","volume":"13 ","pages":"195-206"},"PeriodicalIF":2.9,"publicationDate":"2020-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2147/LRA.S230728","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38696628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}