Prolonged Unconsciousness for Four Days after General Anesthesia

Abstract

  We treated a case of prolonged unconsciousness after general anesthesia. The patient was a 26-year-old woman who had epilepsy and a mild intellectual disability and who had been receiving ongoing treatment with a psychotropic drug and an antiepilepsy drug. General anesthesia was scheduled for the extraction of an impacted wisdom tooth during hospitalization. Intravenous midazolam was administered as a premedication, and general anesthesia was induced using remifentanil, propofol, and rocuronium. Cefmetazole, hydroxyzine, and pentazocine were infused during general anesthesia maintenance with remifentanil and propofol. The duration of operation was 80 minutes, and the duration of the general anesthesia was 160 minutes ; after the operation, she was returned to her room. Her level of consciousness was very clear at 60 minutes after the procedure, but she suddenly lost consciousness while in the lavatory. The unconsciousness persisted for 4 days after the general anesthesia without any abnormalities in her vital signs or neurological findings. Her attending psychiatrist diagnosed the prolonged unconsciousness as postoperative hypoactive delirium. Delirium is very rarely seen in young patient. However, if various combinations of triggers are present, such as the use of opioids and psychotropic drugs, postoperative delirium can occur even in young patients. When postoperative unconsciousness persists without any abnormalities in vital signs or neurological findings, postoperative hypoactive delirium should be suspected after a consideration of the possible triggers.