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Unresponsive postoperative patient
  1. Keng Lam,
  2. Navdeep Sangha
  1. Department of Neurology, Kaiser Permanente LAMC, Los Angeles, California, USA
  1. Correspondence to Dr Keng Lam, Kaiser Permanente LAMC, Los Angeles, CA 90027, USA; keng.lam{at}

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Case presentation

A 53-year-old man was admitted to hospital for elective repair of a descending aortic dissection and type B intramural haematoma. He had a history of stage 3 chronic kidney disease and took aspirin for paroxysmal atrial fibrillation. At 07:00 on the morning of the operation he was awake, alert and moving all limbs. His surgery began at 09:10. He received various anaesthetic medications, including rocuronium 50 mg (0.5 mg/kg); last dose at 17:20. The surgical repair ended at 16:15, and left the operating theatre at around 20:00 after an uneventful surgery.

At midnight, he was still unresponsive despite receiving naloxone. His observations were: temperature 37°C, blood pressure 158/100 mmHg, heart rate 80/min, intubated and breathing at set respiratory rate 14/min, and oxygen saturation 100% on pressor support of 8 cmH2O, tidal volume 580 mL (8 mL/kg of his ideal body weight), FiO2 45%, and positive end-expiratory pressure of 5 cmH2O. He was not on sedation. His pupils were …

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  • Contributors KL wrote the manuscript. NS revised the manuscript. KL prepared and submitted the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed by Jon Walters, Swansea, UK.

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  • Editors’ commentary
    Phil E M Smith Geraint N Fuller

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