Nursing-Patient did not wake after Anesthesia

roser13, ASN, RN · Jul 18, 2016

"Failure to wake" takes many different forms and can originate from many different causes.

Do you mean death?

Do you mean failure to regain consciousness, as in motor recovery but remaining unconscious?

Do you mean patient recovering consciousness, but paralyzed?

Pseudocholinesterase Deficiency is an enzyme deficiency where the body does not metabolize succinylcholine (a paralytic). Thus the patient returns to consciousness but is paralyzed. Is that what you mean?

You have a lot of questions. Are you a nursing student?

loriangel14, RN · Jul 18, 2016

Do you mean they died? Or never awakened again, ever?

xdrowe · Jul 18, 2016

Do you mean they died? Or never awakened again, ever?

I am asking for any and every outcome that anyone has witnessed.

xdrowe · Jul 18, 2016

"Failure to wake" takes many different forms and can originate from many different causes.
Do you mean death?
Do you mean failure to regain consciousness, as in motor recovery but remaining unconscious?
Do you mean patient recovering consciousness, but paralyzed?
Pseudocholinesterase Deficiency is an enzyme deficiency where the body does not metabolize succinylcholine (a paralytic). Thus the patient returns to consciousness but is paralyzed. Is that what you mean?
You have a lot of questions. Are you a nursing student?

Yes I am, thanks for sharing an answer. Have you witnessed any of these?

Editorial Team / Admin · Jul 18, 2016

The vast majority of patients that have not woken up after surgery in my experience are those who either are going to stay vented for several hours (planned before the start of surgery as with our cardiac surgery patients or as a result of what was found during the surgery) or those who aren't metabolizing the anesthetic agents fast enough and will go to the recovery room on a wake-up vent where they are given extra time to metabolize those agents and then be extubated before transferring to the nursing unit. Yes, I've had a patient or 5 die in the OR. Those, however, were not the result of the anesthesia but as a result of either the trauma being beyond what could be repaired (think reaching into the abdomen and feeling the bedsheets because of the depth of an injury) or because of the disease process.

nutella, MSN, RN · Jul 18, 2016

Good afternoon everyone, I am curious about this issue. I had 2 surgeries when I was 18 but it wasn't until a surgery in my 20s that I realized the risk factor in not waking after general anesthesia, are there any medical professionals that have witnessed this happening with a patient. If so, do you mind talking about it. Was there a reason that it happened, and what was the protocol for dealing with a patient when it does happen? All words are welcomed.

It was really not that uncommon before they invented the newer muscle relaxants that have different work time so to speak. Once in a while somebody does not metabolize it and once in a while something else goes wrong that is not noticed eg major stroke.

Back in those days, sometimes the anesthesiologist would think that surgery would last another 3 h and paralyze the pat but the surgeon closed suddenly or earlier - oops.

xdrowe · Jul 18, 2016

It was really not that uncommon before they invented the newer muscle relaxants that have different work time so to speak. Once in a while somebody does not metabolize it and once in a while something else goes wrong that is not noticed eg major stroke.
Back in those days, sometimes the anesthesiologist would think that surgery would last another 3 h and paralyze the pat but the surgeon closed suddenly or earlier - oops.

Thanks for sharing this information! Have you witnessed any reactions such as these?

nutella, MSN, RN · Jul 18, 2016

Thanks for sharing this information! Have you witnessed any reactions such as these?

Yes, in fact I did as I have worked in ICU/critical care and also in anesthesiology as a nurse for like 6 months - I left when I got pregnant (the country in which I worked as RN does not allow nurses to work in anesthesiology when pregnant because of the gases...) and went back to ICU.

It was really not so uncommon to see the anesthesiologist sit with the pat for a while and wait until the stuff wears off or reversed. Really, the invention of propofol and the medium acting relaxants changed a lot. The attending got regularly mad when the fellows were unable to wake the patients up.

Major strokes can happen, I worked in high risk areas and university hospitals. It is not that common but has happened. Also sometimes after heart surgery when the pat was on cardio-pulmonary bypas machine (which back then was normal while now there are also other options for some surgeries).

Having said that - I had anesthesiology a couple of times and never felt anxious or afraid of not waking up.

roser13, ASN, RN · Jul 19, 2016

Yes I am, thanks for sharing an answer. Have you witnessed any of these?

Ummm, yes. Have managed many such cases.

Trauma Columnist · Jul 19, 2016

Moved to nursing student assistance

xdrowe · Jul 19, 2016

Moved to nursing student assistance

Thanks!!