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EMAK
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Joined: 26 Nov 2006
Posts: 572
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 Posted: Fri Jan 19, 2007 8:06 pm Post subject: GA & delayed recovery |
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Peri-operative blood transfusion of more than 3 units is a recognised cause of delay recovery of more than 30 minutes after GA.......
If we think of hypothermia.it will be true
If we check causes of delayed recovery a part from hypothermia......it has not been mentioned frankly........
Any opinions,references pls...
Last edited by EMAK on Fri Jan 19, 2007 9:25 pm; edited 1 time in total |
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wolverine
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Joined: 16 Jan 2007
Posts: 394
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| Posted: Fri Jan 19, 2007 9:10 pm Post subject: |
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| 390 minutes??!! This is 6 and 1/2 hours!! If I have to answer from my everyday clinical experience I'd say false! (Does not mean that my patients have to have 3 units transfusion everyday!). It makes sense for recovery to be delayed after transfusion (hypoxaemia, hypovolemia, possible hypothermia) but this is too much! No? |
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EMAK
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| Posted: Fri Jan 19, 2007 9:23 pm Post subject: |
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30 minutes.  |
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Nick Raine-Fenning
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Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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| Posted: Fri Jan 19, 2007 11:17 pm Post subject: |
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Recognised is a powerful and friendly word as it almost always makes the answer true 
I agree with wolverine and his explanation - the things associated with transfusion including the need for it will increase the possibility of delayed recovery.
What other causes are there? This is a more important question and the RCOG tell you this on their website as they say the Past Paper book is meant as a learning tool that is intended to direct your revision. I would like to see some more discussion of these points if possible otherwise we will end up with 2500 + posts (excluding the repeated questions) aimed at each and every question in the book. Trust me - discusion around the topic / stem will bring more marks in the exam.
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Last edited by Nick Raine-Fenning on Sat Jan 20, 2007 8:11 am; edited 1 time in total |
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EMAK
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Joined: 26 Nov 2006
Posts: 572
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| Posted: Sat Jan 20, 2007 7:37 am Post subject: |
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Other causes of Delayed recovery are:
anaesthetic Overdose
Duration and type of anaesthetic given
Potentiation by other drugs. Prior ingestion of sedative premedication such as benzodiazepines, or alcohol
Prolonged neuromuscular blockade
Respiratory Failure
Metabolic Derangements(Hypoglycemia.Severe hyperglycemia,Electrolyte imbalance likehyponatraemia ,Hypothermia, Central anticholinergic syndrome )
Neurological Complications (like;Cerebral hypoxia ,Intracerebral event such as haemorrhage, embolism or thrombosis0,etc.
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Nick Raine-Fenning
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Location: Nottingham
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| Posted: Sat Jan 20, 2007 8:13 am Post subject: |
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Good work EMAK!
Assessment of a patient with delayed recovery following a hysterectomy is a great question. So good in fact I have set the question over in the SAQ Forum.  |
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wolverine
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| Posted: Sat Jan 20, 2007 8:46 am Post subject: |
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| I would think of pre-existing renal or liver insufficiency therefore delayed clearance of the anesthetic agents |
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EMAK
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Joined: 26 Nov 2006
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| Posted: Sat Jan 20, 2007 8:54 am Post subject: |
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| Actually I still think of this....more than 3 units blood...could be 10..so a part from hypothermiasupposing the blood is adquately wormed....there will be the hyponatramia..........so it could be truely recognised cause. |
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Nick Raine-Fenning
Course Director
Joined: 27 May 2006
Posts: 1852
Location: Nottingham
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| Posted: Sat Jan 20, 2007 11:07 am Post subject: |
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| You are over-complicating the question. As wolverine mentioned the fact blood was necessary suggests significant intraoperative blood loss and this alone is enough to delay recovery. |
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pass07
Joined: 07 Feb 2007
Posts: 26
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| Posted: Sat Feb 10, 2007 12:51 pm Post subject: |
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| what about concurrent use of hypotensive agents: will that not delay recovery? |
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rpwalavalkar
Teale Fenning Administrator
Joined: 20 Jul 2006
Posts: 966
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| Posted: Sat Feb 10, 2007 1:01 pm Post subject: |
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u r right. it will and does. hence the flutter our friends at the head end go thru bout the bp.
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Dr Miss. Raj Walavalkar MBBS MRCOG
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SR O&G Wessex Region |
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