Delayed Recovery From Anesthesia Revealing Unrecognized Metabolic Acidosis and Hypokalemia in a Patient With Urinary Diversion

Delayed recovery from anesthesia may result from unrecognized metabolic and electrolyte abnormalities. We report a case of an 18-year-old female with prior ureterosigmoidostomy who underwent ureteric reimplantation under general anesthesia. She was found to have severe hypokalemia with metabolic acidosis in the perioperative period, which had not been identified preoperatively. Postoperatively, she exhibited neuromuscular weakness and inadequate respiratory effort, requiring elective ventilation. Correction of the underlying abnormalities resulted in rapid recovery and successful extubation. This case highlights the importance of preoperative metabolic evaluation and optimization in patients with urinary diversion to prevent delayed emergence and respiratory compromise.