Emergence From Anesthesia

Emergence from general anesthesia and tracheal extubation is frequently associated with an intense physiologic and metabolic response. These reactions may lead to homeostasis alterations, especially in patients with comorbidities. Neurosurgical patients are at higher risk to develop complications during the emergence from anesthesia resulting in significant morbidity and mortality. Early awakening and extubation under respiratory and cardiovascular stability are the main goals during emergence from anesthesia in a neurosurgical patient. Nevertheless, rapid emergence may impose an increased risk in some patients. Intracranial hemorrhage, hematomas, and cerebral edema with consequent cerebral hypoperfusion are the most concerning complications after an intracranial surgery. Blood pressure changes, hypoxia, and hypercapnia are some of the main factors associated with these events. Coughing and bucking after surgery also trigger an important sympathetic stimulation with concomitant increased venous pressure. Prolonged emergence or delayed arousal from anesthesia after neurosurgery is a concern for both, surgeon and anesthesiologist. Anesthesia technique, area of the brain affected by surgery or trauma, size of the lesion, and preoperative medications are the variables influencing both the emergence and arousal stages.