• Delayed recovery
    • Pharmacological
      • Benzodiazepines
        • Midazolam is metabolised by the same p450 iso-enzyme
      • Opioids
        • Reduce clearance of volatiles, cause hypercapnoea etc
      • NMBDs
      • IV induction agents
        • Typically 80% reduction in effect site concentration is required for awakening
      • Volatile agents
        • Awakening is usually at about 0.3 MAC
    • Metabolic
      • Hypoglycaemia
        • BG <2.2 mmol/L
      • Hyperglycaemia
        • BG >14 mmol/L
      • Hyponatraemia
        • <120 causes confusion
      • Hypernatraemia
        • Less common
      • Uraemia
      • Hypothermia
        • <35 degrees
    • Uncommon causes
      • Central anticholinergic syndrome
      • Dissociative coma
      • Myxoedema
    • Neurological
      • Air embolus
      • LA
      • Intracranial pathology
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/6/3/114.full.pdf