Differentials

Question 1

Delayed emergence Ddx

Answer 1

Neuro:
- residual anesthetic
- narcotics or benzos
- residual neuromuscular blockade (esp if patient has condition/meds that potentiates blockade)
- CVA
- tension pneumocephalus
- drugs/EtOH/toxins
- hypothermia (decreases drug metabolism and MAC)

Cardiac:
- hypotension

Pulm:
- hypoxemia
- hypercarbia/hypocarbia
- hyper/hyponatremia

Endocrine:
- hypoglycemia/hyperglycemia
- hypothyroidism

Question 2

AMS after cerebral aneurysm rupture ddx

Answer 2

• post op vasospasm
• delayed cerebral ischemia
• cerebral edema
• hematoma (greatest risk first 12 hrs)
• pneumocephalus
• hydrocephalus
• seizure
• cardiopulmonary dysfunction
• electrolyte abnormality (eg hypoNa)

Question 3

Post op vision loss ddx

Answer 3

• corneal abrasion (pain worse with blinking, foreign body sensation, conjunctivitis, photophobia)
• acute glaucoma (pain, pale eye, dilated pupil)
• glycine toxicity (temporary, usually resolves in 24 hrs)
• cortical blindness (absent response to visual threat, normal pupillary response, unable to follow moving objects with head stationary)
• hemorrhagic retinopathy (floaters, pre-retinal hemorrhage)
• retinal ischemia (pale retina, painless vision loss) (branch or central retinal artery occlusion, cherry red macula in CRAO)
• ischemic optic neuropathy (painless, impaired light reflex)