Postoperative Delirium

By Taylor Redd '18

Everyone has their quirks. Everyone has different aspects to their personality that are unique to them. Everyone has “little rituals”—or perhaps a ritual of not having rituals—he or she does everyday, intentional or not. For instance, some people prefer to wake up to a certain song every morning as their alarm. Others subconsciously fold their laundry in a specific way: socks and underwear in one pile, t-shirts in another. A brave few religiously wake up early to go on a run outside every morning before the sun rises—I am certainly not included in that group. Regardless of what “ritual” you do, everyone has some quirk that is unique to them (unless your ritual is getting Starbucks every morning—then you aren’t so unique and are more so just a cliché. I include myself in that group.) Odds are, years and years from now, you’ll still be folding your laundry the same way as always.

What if in fifty years from now, you had to undergo a major surgery: either you threw out your hip after pop-locking and dropping it one too many times, or you need to undergo coronary bypass surgery because all those Shake Shack burgers of the past few decades finally decided to get back at you by clogging your arteries. Regardless of what exact surgery it is, any major operation presents a plethora of risk factors to its patient and those risk factors only increase as you grow older. One of the most common yet elusive risk factors in elderly patients is identified as postoperative delirium.

Classified into three categories of hypoactive, hyperactive, and mixed, postoperative delirium is an acute confusional state that interferes with a patient’s reticular activation system, which controls an individual’s sleep-wake cycle, cognition, and degree of focus. In the hyperactive category, postoperative delirium sends a patient into a heightened state of agitation and disorientation which may lead to incoherent speech, hallucinations, and delusions. This is the most common form in postoperative victims. In contrast, hypoactive delirium causes patients to feel sluggish and drowsy or withdrawn from reality.

Unfortunately, the world of medicine has yet to determine an exact mechanism that relates to why such striking numbers of elderly patients suffer from delirium after surviving a major operation. In several different studies by the Mayo Clinic, it has been revealed that many of the preoperative narcotics given to a patient before major surgery disrupt the brain’s natural functions such as those controlled by the reticular activation system. Due to the natural effects of aging, elderly patients’ brains work at a slower and less efficient pace. As a result, patients older than about 65 are more prone to the negative side effects of preoperative narcotics and falling into postoperative delirium.

While the causes of this type of delirium are not easily traced, doctors have recognized a wide variety of methods to prevent and treat postoperative delirium. Antipsychotics may be administered to a hyperactive patient over a period of twelve hours in severe cases of delirium; however, doctors at the National Library of Medicine encourage alternative methods of treatment that involve reorienting a patient with reality by making them feel comfortable in the room.

Now to get back to my point about the “little rituals”-- I promise that wasn’t just another tangent of mine. The condition of elderly patients who suffered from postoperative delirium drastically improved by familiarizing them with their life prior to surgery. This can be done by ensuring a patient has the means to pursue his or her “little rituals.” Small things such as playing a patient’s favorite kind of music, hanging pictures, or even just sharing memories from the past can help treat postoperative delirium. A patient should also be given his or her glasses or hearing aid if that was something they had grown accustomed to wearing prior to surgery. It is crucial to have a strong support system of family and friends to help elderly patients return to their lives as closely as possible—whether that means playing your grandma’s strange music every morning, or folding laundry washed in Armor Hammer detergent, any little thing can help.

Deiner, S., and J. H. Silverstein. "Postoperative Delirium and Cognitive Dysfunction." Postoperative Delirium and Cognitive Dysfunction | BJA: British Journal of Anaesthesia | Oxford Academic. Oxford University Press, 01 Dec. 2009. Web. 15 Feb. 2017.

"Postoperative Cognitive Dysfunction in Elderly Patients: A Frequent Complication." Journal of Anesthesia & Critical Care: Open Access 2.2 (2015): n. pag. Web.

"Serum Anticholinergic Activity and Postoperative Cognitive Dysfunction in Elderly Patients." Anesthesia and Analgesia. U.S. National Library of Medicine, n.d. Web. 15 Feb. 2017.

"Serum Anticholinergic Activity in a Community-based Sample of Older Adults: Relationship with Cognitive Performance." Archives of General Psychiatry. U.S. National Library of Medicine, n.d. Web. 15 Feb. 2017.