Delayed Emergence Following the Implementation of Chronic Pain Recommendations (CPR): A Case Report

Lumbar spine surgery is amongst the most common neurosurgical procedures performed on a global scale. Prospective patients range with presenting levels of health, rendering each case as truly individualized. Despite contrasting etiologies that prompt surgical intervention, patients are commonly well adjusted to healthcare environments secondary to chronic pain. Unresolved nociception often exceeds the capabilities of conservative measures, leaving spinal instrumentation as the final resort. Stemming from its highly invasive nature, complications can originate from surgical manipulation, mechanical instrumentation and/or complex anesthetic requirements. An underappreciated and habitually underreported phenomenon following general anesthesia is delayed emergence. Although the context of delayed emergence is mostly confined to the domain of pediatrics, it holds clinical significance in specific patient populations. The ensuring case study highlights the perioperative course of an individual patient presenting with symptomatic spinal stenosis and neurogenic claudication, necessitating surgical intervention in the form of L2-S1 posterior lumbar fusion and L4-L5 revision discectomy. The outcomes of the selected case, as supported by current literature, suggests that delayed anesthetic emergence can be predicted and can routinely be mitigated via appropriate modalities, aimed at addressing the underlying cause(s).