| Cause | Investigation or Intervention |
|---|---|
| Anesthetic Related Residual drug effects (inhalational anesthetics, opioids, propofol) Nonanesthetic medications (recreational drugs [cocaine], herbal medicines [Valerian, St. Johns wort]) Depressed neuromuscular junction, residual neuromuscular blockade, pseudocholinesterase deficiency Hypothermia Severe hypercapnia | End-tidal concentration Evaluate total drug dose History Drug toxicology screen Assess train of four Measure child's temperature Introduce heating modalities as indicated (forced-air warmer, heat operating room) Arterial blood gases and PetCO2 |
| Metabolic Hypoglycemia, hyperglycemia, metabolic acidosis Electrolyte and metabolic disorder Acid–base disturbance Encephalopathy (hepatic, renal, endocrinopathy [hypothyroidism, Addison disease]) Sepsis Cerebrovascular accident/hypoxia | Measure blood glucose
Measure urinary glucose and ketones Arterial blood gas and electrolytes for pH and ion gap Serum electrolytes (hyponatremia, hypomagnesemia) Blood gas analysis (anion gap or non–anion gap acidosis) Blood gas analysis Electrolytes Blood cultures Check bilateral pupil size Check responsiveness to light and pain bilaterally Assess the presence of a gag reflex and symmetrical limb reflexes Assess the fontanel pressure in infants |