Psychogenic coma following upper endoscopy: a case report and review of the literature.
BACKGROUND
Failure to regain consciousness after general anesthesia has a multitude of life-threatening causes, including neurological injury, metabolic derangements, or drug effects. Failure to promptly recognize the cause of unconsciousness after anesthesia can result in significant patient morbidity or mortality, costly laboratory and radiographic evaluation, and physician anxiety. Rarely, patients fail to awaken after anesthesia due to a psychiatric cause. The early recognition of psychogenic coma can result in reduced iatrogenic complications, hospital cost, and physician anxiety.


METHODS
We present a case of a 28-year-old female who became unresponsive after general anesthesia for an upper endoscopy. Physical, laboratory, and radiographic examination after the procedure revealed no apparent organic cause for her failure to awaken. The patient spontaneously awoke after 16 hours without neurological deficit.


CONCLUSIONS
We reviewed the literature and identified 10 previously reported cases of postanesthesia psychogenic coma. We have compared and contrasted our case with the 10 previous reports and propose bedside clues to assist the physician with diagnosing this unusual condition.
Downs
John W
JW
Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Young
Patrick E
PE
Durning
Steven J
SJ
D000328:Adult; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D003128:Coma / Q000139:chemically induced* / Q000209:etiology / Q000523:psychology; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D018662:Fundoplication; D015600:Glasgow Coma Scale; D006801:Humans; D015742:Propofol / Q000009:adverse effects*; D012307:Risk Factors
D018686:Anesthetics, Intravenous; D005283:Fentanyl; D015742:Propofol