Global Perspectives on Obstetric Anesthesia: Challenges and Priorities for Advancing Maternal Health

Emergence from anesthesia can be monitored by observing and examining the patient. The physiologic signs and neurologic function in the different phases of emergence can be attributed to the return of function of different parts of the patient’s brainstem. The signs related to each phase are: Phase 1 • Cessation of anesthetic drugs • Reversal of peripheral-muscle relaxation (akinesis) • Transition from apnea to irregular breathing to regular breathing • Increased alpha and beta activity on EEG Phase 2 • Increased heart rate and blood pressure • Return of autonomic responsiveness • Responsiveness to painful stimulation • Salivation (CN VII and IX nuclei) • Tearing (CN VII nuclei) • Grimacing (CN V and VII nuclei) • Swallowing, gagging, coughing (CN IX and X nuclei) • Return of muscle tone (spinal cord, reticulospinal tract, basal ganglia, and primary motor tracts) • Defensive posturing • Further increase in alpha and beta activity on EEG • Extubation possible Phase 3 • Eye-opening • Responses to some oral commands • Awake patterns on EEG • Extubation possible