Delayed Awakening Following General Anesthesia in a 74-Year-Old Female Patient: An Interplay of Physiological and Psychological Factors

Delayed awakening and postoperative agitation pose significant challenges in geriatric anesthesia. This report discusses a 74-year-old female with hypertension and notable preoperative anxiety who underwent laser ablation of a laryngeal tumor under general anesthesia. Despite a hemodynamically stable 1.5-hour procedure, the patient remained unresponsive for over two hours and subsequently developed significant agitation, scoring +2 to +3 on the Richmond Agitation-Sedation Scale. Arterial blood gas analyses were unremarkable, and common pharmacological or metabolic causes were excluded. She spontaneously recovered after approximately three hours, with her family reporting a nearly identical episode two years prior alongside a history of a stubborn temperament, suggesting a potential psychological component. This case highlights that delayed awakening in the elderly can be multifactorial, where psychological predispositions may amplify pharmacological effects. It advocates for integrating psychological assessment into preoperative planning for vulnerable older adults and calls for more research into personalized anesthesia protocols addressing both physiological and mental health factors.