Postoperative Delirium

Definition

Postoperative delirium is an acute disorder of attention and cognition detected typically in the PACU but can be noted up to 3 days after surgery. Patients are usually noted to have altered consciousness and orientation.

Recognition

Postoperative delirium can have multiple causes and should be promptly evaluated by an anesthesiologist in the PACU. Assessment of the patient’s breathing and circulatory status is extremely important to rule out life-threatening problems such as hypoxia, hypercarbia, and airway obstruction. A thorough medical history, a complete listing of medications administered during the perioperative period, and review of the anesthesia and surgical course (including the type of surgery) should be obtained. Then a detailed physical examination and any indicated laboratory testing are performed.

Severe pain (surgical, urinary, or gastric distention) can cause altered mental status and should be treated promptly. Certain metabolic, endocrine, and infectious disorders can also cause altered mental status and must be ruled out. Intracerebral pathology should be ruled out in patients with focal neurologic findings and gait disturbances. In addition, effects of residual anesthetic agents may mimic postoperative delirium. It may be difficult to distinguish residual sedation resulting from the effects of sedatives, antiemetics, or anesthetics that lead to disinhibition from causes that require treatment with sedatives.

Patients with postoperative delirium are at risk of physically harming themselves or PACU personnel. Patients may tear open their bandages or wounds or pull out their intravenous lines. Patients with postoperative delirium are also at risk for falls and fractures.