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Delayed recovery of consciousness after anesthesia
Pérdida de conciencia en el postoperatorio inmediato
R. López Herrero
, P. Rubio Babiano, B. Sánchez Quirós, C. del Rey de Cabo
Corresponding author
Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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TC cerebral donde se aprecia una extensa área de edema vasogénico (flecha amarilla) hemisférico derecho que afecta a la región fronto-parietotemporal, visualizando una lesión ocupante de espacio (flecha azul) en el seno de esta, con hipercaptación periférica de contraste (captación en anillo) de 46<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>39<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>59<span class="elsevierStyleHsp" style=""></span>mm.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">B. TC cerebral donde se aprecia un gran efecto masa con colapso de surcos corticales derechos, colapso del asta temporal del ventrículo lateral derecho y parcial del asta frontal, desplazamiento de la línea media (flecha roja) hacia la izquierda 10<span class="elsevierStyleHsp" style=""></span>mm y borramiento de cisternas basales y perimesencefálicas, que sugieren herniación subfalciana y transtentorial.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. López Herrero, P. Rubio Babiano, B. Sánchez Quirós, C. del Rey de Cabo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "López Herrero" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Rubio Babiano" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Sánchez Quirós" ] 3 => array:2 [ "nombre" => "C." 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B) In most cases, this heart block is considered high risk for complete AVB and permanent pacemaker implantation is frequently indicated, particularly in the presence of a QRS with a bundle branch block pattern. In the event of a surgical emergency, the placement of a temporary pacemaker (electrocatheter) should be considered. Image C) shows lead DII of the ECG in different types of AVB. Pacemaker implantation prior to surgery is based on visual assessment. a) Normal ECG: all P waves conduct. PR<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>200 msg. b) 1st degree AVB: all P waves conduct. PR<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>200 msg. 2nd degree AVB: some P waves conduct. c) Mobitz I (Wenckebach): progressive lengthening of the PR interval until conduction block. d) Mobitz II: constant PR. Non-conducted P waves. e) Type 2:1: intermittent non-conducted P waves (1 conducts and another does not). Typically with HR of 40–50x’. f) 3rd degreed AVB (complete): non-conducted P wave. Usually with extreme bradycardia (30–35x’) and wide QRS. (Solid arrow, P-wave conducts; dotted arrow, P-wave does not conduct).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Tatjer, A. Ruíz, E. Guasch, X. Sala-Blanch" "autores" => array:4 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Tatjer" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Ruíz" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Guasch" ] 3 => array:2 [ "nombre" => "X." 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López Herrero, P. Rubio Babiano, B. Sánchez Quirós, C. del Rey de Cabo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "López Herrero" "email" => array:1 [ 0 => "rociolopezherrero@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Rubio Babiano" ] 2 => array:2 [ "nombre" => "B." "apellidos" => "Sánchez Quirós" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "del Rey de Cabo" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario de Valladolid, Valladolid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pérdida de conciencia en el postoperatorio inmediato" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 593 "Ancho" => 1005 "Tamanyo" => 63238 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Brain CT scan showing an extensive area of vasogenic oedema (yellow arrow) in the right fronto-parietotemporal region enclosing a 46 × 39 × 59 mm space-occupying lesion (blue arrow) with peripheral hyper-uptake of contrast (ring enhancing lesion).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Our patient was a 66-year-old man with a history of stroke, low-grade bladder carcinoma and a 2-month history of weakness in the lower extremities. He consulted due to lower back pain, jaundice and dark urine for the previous 3 days, and was admitted with a diagnosis of haemorrhagic necrotising pancreatitis of biliary origin and scheduled for surgery. Upon arrival in the operating room, he was conscious and stable. The intervention (cholecystectomy) was uneventful, and the patient was extubated in the operating room. Twenty minutes later, he presented loss of consciousness, desaturation, and sudden hypotension. The stroke code was activated, and the patient was re-intubated. A brain CT scan revealed a space-occupying lesion with vasogenic oedema (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) and subfalcine and transtentorial herniation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The patient made slow progress, and eventually died.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">B. Brain CT showing a large mass effect with collapse of the right cortical sulci, collapse of the temporal horn of the right lateral ventricle and partial collapse of the frontal horn, 10 mm midline shift (red arrow) to the left, and effacement of basal and perimesencephalic cisterns, suggesting subfalcian and transtentorial herniation.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López Herrero R, Rubio Babiano P, Sánchez Quirós B, del Rey de Cabo C. Pérdida de conciencia en el postoperatorio inmediato. Rev Esp Anestesiol Reanim. 2022;69:379.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 593 "Ancho" => 1005 "Tamanyo" => 63238 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A. Brain CT scan showing an extensive area of vasogenic oedema (yellow arrow) in the right fronto-parietotemporal region enclosing a 46 × 39 × 59 mm space-occupying lesion (blue arrow) with peripheral hyper-uptake of contrast (ring enhancing lesion).</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006900000006/v1_202207050820/S2341192922000981/v1_202207050820/en/main.assets" "Apartado" => array:4 [ "identificador" => "70433" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images of the month" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006900000006/v1_202207050820/S2341192922000981/v1_202207050820/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192922000981?idApp=UINPBA00004N" ]
