Failure to Wake from Anaesthesia

🔑 Key Priorities

• Exclude common reversible causes

• Maintain safety and airway control while investigating

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🧠 Team Actions

Role	Task
Team Leader	Guide stepwise approach, lead reassessment
Airway Manager	Reassess ventilation, CO₂, oxygenation
Circulation	Check temperature, glucose, drugs

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🧭 Management Algorithm

1. Check ABCs: airway, breathing, circulation

2. Common reversible causes (mnemonic “DIMS”):

   • Drugs: residual anaesthesia/opioids/benzos/muscle relaxants

   • Imbalance: glucose, sodium, calcium, temperature

   • Metabolic: CO₂ retention, liver/kidney dysfunction

   • Structural: CVA, seizure, head injury, raised ICP

3. Use neuromuscular monitor and consider reversal (sugammadex or neostigmine)

4. Consider naloxone (20–40 mcg IV) or flumazenil (0.2 mg IV)

5. ABG + BSL + electrolytes

6. CT brain if suspicion for structural cause

7. ICU referral if not rapidly improving

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🔄 Ideal Crisis Flow

        Failure to Wake Post-Anaesthesia
                    ↓
           ABCs + Monitor + Oxygenation
                    ↓
         DIMS: Drugs, Imbalance, Metabolic, Structural
                    ↓
         Trial Reversal Agents + Check Labs
                    ↓
          CT Brain ± ICU if No Improvement