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Failure to wake (Drugs (Residual anaesthesia (Confirm anaesthetic agents…
Failure to wake
Drugs
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Residual NMB, Sux apnoea
Check doses and timing of NMB and reversal. Double burst stimulation using a peripheral nerve stimulator (painful).
Other sedating agents e.g. opioids, benzos (deliberate or drug error)
Check doses and timing, confirm no drug error against ampoules if available
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Management
The cause of somnelance is secondary to managing airway, breathing and circulation. I would apply 100% 02 via bag and mask to ensure adequate ventilation while simultaneously assessing colour, circulation and checking her post op observations (BP, HR, RR, Sp02 and temp)
Get ABG
Check oxygenation, hypercarbia, electrolytes, BSL
Check temp, neurological assessment
Check drugs
Anaesthetic, NMB, opioids, benzos, anticholinergic syndrome
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Neurological (CVA, seizure - postictal)
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