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Neurologic changes during awakening from anesthesia

H Rosenberg, R Clofine, O Bialik

    Anesthesiology
    |February 1, 1981
    PubMed
    Summary
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    Neurologic signs like hyperreflexia can occur temporarily after anesthesia. Enflurane-nitrous oxide anesthesia was associated with the most abnormal neurologic signs during patient awakening.

    Area of Science:

    • Anesthesiology
    • Neuroscience
    • Clinical Medicine

    Background:

    • Transient neurologic signs, including hyperreflexia and Babinski reflex, are known to occur post-anesthesia in healthy individuals.
    • The manifestation and duration of these signs can be influenced by the anesthetic agent used, time elapsed since anesthesia cessation, and the patient's arousal state.

    Purpose of the Study:

    • To describe the appearance and duration of transient neurologic signs following general anesthesia.
    • To correlate these neurologic signs with specific anesthetic agents (halothane-nitrous oxide, enflurane-nitrous oxide, nitrous oxide-narcotic), time post-anesthesia, and arousal state.
    • To compare the neurologic profiles during awakening across different anesthetic techniques.

    Main Methods:

    • Twenty-nine neurologically normal male patients undergoing superficial surgery were studied.

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  • Anesthesia was administered using halothane-nitrous oxide, enflurane-nitrous oxide, or nitrous oxide-narcotic combinations.
  • Neurologic examinations were performed during the awakening period to assess reflexes, clonus, plantar responses, shivering, and pupillary light response.

    • Main Results:

    • Transient hyperreflexia and shivering were observed with all anesthetic techniques.
    • Enflurane-nitrous oxide anesthesia was associated with the highest incidence of quadriceps hyperreflexia (7/12 patients), sustained ankle clonus (50% of patients), and upgoing plantar responses (50% of patients).
    • Neurologic abnormalities were most frequent in patients with poor responsiveness to verbal commands and could persist for over 40 minutes post-anesthesia.

    Conclusions:

    • The neurologic profile during awakening from general anesthesia is most abnormal following enflurane-nitrous oxide compared to halothane-nitrous oxide and nitrous oxide-narcotic anesthesia.
    • Abnormal neurologic signs are more prevalent in less responsive patients and diminish over time.
    • Lash and pupillary reflexes normalized with the return of consciousness, irrespective of the anesthetic agent used.