Recommended Citation
Wojcik C, Ghaly R, Yeh C. Awakening a patient with congenital deafness from general anesthesia. Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Presentation Notes
Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Abstract
Introduction: Emergence from general anesthesia signifies the waning of the anesthetic effect and the recovery of consciousness. After general anesthesia, one criterion for extubation is the ability to follow simple commands. The ability to follow commands demonstrates that the patient has adequate consciousness, can protect their airway, and can coordinate basic movements, which suggests an ET tube can be safely removed. Congenital deafness thus presents an obstacle for the Anesthesiologist to communicate with a patient as they awaken from general anesthesia. Case Presentation: A 44-year-old female with a history of congenital deafness and bilateral DCIS S/P bilateral mastectomy presents for breast reconstruction with implants. An in-person ASL interpreter was present to assist in facilitating a safe induction of general anesthesia, which was occurred without issue. Muscle relaxation was achieved with rocuronium and maintenance of general anesthesia was achieved with sevoflurane. The case concluded without complication. An ASL interpreter was not available for extubation. Neuromuscular blockade was reversed with Sugammadex. As sevoflurane weaned, patient was breathing spontaneously without pressure support. Because commands were unable to be communicated to the patient, we waited for patient to spontaneously open her eyes. To keep the patient comfortable and prevent coughing against the endotracheal tube after breast surgery, we administered 25 mg of transtracheal lidocaine via the ETT. After approximately 20 minutes, the patient opened her eyes, at which point her end tital sevoflurane concentration was 0%. She was extubated safely and was taken to the PACU without issue. Conclusion: To safely remove an endotracheal tube after general anesthesia, it is important to assess whether the patient has regained adequate consciousness and basic motor coordination to ensure they can maintain their own airway after extubating. To assess the return of these functions, patients are asked to perform basic motor commands prior to extubating (1). Congenital deafness presents an obstacle in communicating these commands to the patient. There is an absence of literature regarding anesthestic management of patient with deafness. A prior report has utilized BIS monitoring to assess levels of consciousness in an adolescent patient (2). We recommend extubating at your own comfort level while preserving the safety of the patient. 1. Benham-Hermetz J, et al. (2021) BJA Educ. 21(12):446-454. 2. Yi-Chun Chen, et al. (2010) Acta Anaesthesiologica Taiwanica 48(4):185-187
Type
Oral/Podium Presentation
Affiliations
Advocate Illinois Masonic Medical Center