Clinical signs are masked. A sudden onset of coughing, cyanosis, unexplained hypotension or cardiac arrest are hallmark signs, and their occurrence should be noted carefully, particularly when they are associated with a change in patient position. Instrument (e.g., transoesophageal) detection methods are particularly valuable.
Unfortunately, the diagnosis is often only made at the end of surgery: • either because neurological signs occur suddenly after normal wakening, or
• because awakening is slow, the patient is confused or agitated, or remains semi comatose with neurological deficits or seizures (these are the most common presentations), or
• because anaesthetic sleep is followed by a deep coma. This indicates massive GE with a very poor prognosis.
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