Fukura Rena, Ishida Yusuke, Kaneda Yuri, Oe Katsunori
Anesthesiology, Showa University School of Medicine, Tokyo, JPN.
Anesthesiology, Showa University Fujigaoka Hospital, Yokohama, JPN.
Cureus. 2024 Dec 10;16(12):e75513. doi: 10.7759/cureus.75513. eCollection 2024 Dec.
Postoperative disorders of consciousness can arise from various factors, making diagnosis challenging. This report presents a case of a disorder of consciousness that occurred after awakening from general anesthesia, in which various examinations including computed tomography (CT) and magnetic resonance imaging (MRI) were conducted, but the cause could not be identified. A man in his 60s with a history of hypertension and cerebral hemorrhage underwent revision total hip arthroplasty under general anesthesia for a left periprosthetic hip fracture. The induction and maintenance of anesthesia were uneventful. Postoperatively, anesthesia was discontinued, and the patient responded to verbal commands, opened his eyes, and was able to follow handgrip instructions, allowing for extubation. However, after moving to the recovery room, his level of consciousness decreased, reaching a Glasgow Coma Scale score of E3V1M3-4. Suspecting prolonged effects of the anesthetic agents, his condition was observed in the recovery room for approximately 30 minutes, but there was no change in his level of consciousness. CT and MRI of the head were performed, but no significant abnormalities were found. Electroencephalogram monitoring did not show any clear epileptiform activity. Gradual improvement in his level of consciousness was noted 60-120 minutes after the initial decline. Subsequently, there were no further episodes of disordered consciousness. Perioperative disorders of consciousness are challenging to diagnose due to the potential effects of anesthetic agents. Although the cause could not be identified in this case, the patient fortunately recovered consciousness without any significant sequelae.
术后意识障碍可由多种因素引起，这使得诊断颇具挑战性。本报告介绍了一例全身麻醉苏醒后出现的意识障碍病例，在此病例中进行了包括计算机断层扫描（CT）和磁共振成像（MRI）在内的各种检查，但病因未能明确。一名60多岁有高血压和脑出血病史的男性因左人工髋关节周围骨折在全身麻醉下行翻修全髋关节置换术。麻醉诱导和维持过程顺利。术后，停止麻醉，患者对言语指令有反应，睁眼，能遵循握手指令，于是进行了拔管。然而，转至恢复室后，他的意识水平下降，格拉斯哥昏迷量表评分为E3V1M3 - 4。怀疑是麻醉剂的持续作用，在恢复室对其病情观察了约30分钟，但他的意识水平没有变化。进行了头部CT和MRI检查，但未发现明显异常。脑电图监测未显示任何明确的癫痫样活动。在最初意识水平下降60 - 120分钟后，注意到他的意识水平逐渐改善。随后，未再出现意识障碍发作。由于麻醉剂的潜在影响，围手术期意识障碍的诊断具有挑战性。尽管该病例病因未能明确，但幸运的是患者恢复了意识，未留下任何明显后遗症。
