Chậm tỉnh sau gây mê toàn thân trên bệnh nhân được phẫu thuật tuyến giáp: Báo cáo ca lâm sàng

Delayed emergence after general anesthesia (DEA) is a rare yet clinically significant complication that presents considerable diagnostic challenges and causes anxiety for both medical professionals and patients' families. Prompt and accurate management is crucial for optimal patient outcomes. This case report aims to highlight the complexities associated with DEA, particularly in the context of thyroid surgery, and to emphasize the importance of early recognition and the development of tailored treatment strategies. It contributes to understanding these challenging situations and the need for individualized approaches in general anesthesia practice.

Medical professionals, specifically anesthesiologists, surgeons, medical residents, and researchers interested in anesthesiology and patient safety.

Delayed emergence after general anesthesia (DEA), defined as a failure to awaken within 60 minutes of anesthetic cessation, is a rare but challenging complication, occurring in 0.25-1% of cases. This paper presents the case of a 40-year-old female patient who experienced delayed recovery following general anesthesia for thyroid surgery. Despite an uneventful anesthetic induction and maintenance, and normal preoperative assessments, the patient exhibited a prolonged delay in awakening without clear clinical or laboratory abnormalities. Initial management involved close monitoring and minimal supportive interventions. The investigation systematically ruled out common causes, including residual anesthetic drugs (Desflurane, Propofol, Rocuronium), metabolic disturbances (hypoglycemia, electrolyte imbalance, hypothyroidism), and central nervous system injuries (stroke, epilepsy). The authors propose a hypothesis focusing on increased sensitivity to anesthetics, specifically Propofol, potentially linked to genetic polymorphisms (e.g., CYP2B6, UGT1A9) that affect drug metabolism and excretion. This genetic variability can lead to prolonged half-lives and accumulation of anesthetics, even with standard dosing. The case underscores the necessity for clinicians to recognize delayed awakening from anesthesia early, explore medical literature for comprehensive monitoring and treatment strategies, and consider individualized approaches based on potential genetic predispositions in general anesthesia practice. This approach is crucial for improving patient outcomes and safety in situations involving delayed recovery.