Recurrent psychogenic coma following tracheal stenosis repair

Medication, intracranial hemorrhage, infarction, infection, hypoxia, organ failure, and nutritional deficiency may cause unconsciousness following suc cessful emergence from anesthesia. A 39-year-old woman with a history of tr acheal stenosis, depression, and anxiety had complete unconsciousness on 3 separate occasions following surgical repair of her tracheal stenosis. In e ach case, the patient's endotracheal tube had been removed; she was alert a nd oriented to person, time, and place; and she was admitted to the hospita l for observation. Within a few hours after the tube was removed, the patie nt became abruptly unconscious for periods of 36, 18, and 30 hours. Each ti me, the results of cardiac, pulmonary, metabolic, and neurologic examinatio ns and radiological studies were normal. We hypothesize that the patient's apparent comas were the result of an underlying conversion disorder precipi tated by unresolved psychological conflict surrounding a long history of ab use in which she was repeatedly smothered by a pillow.