Citation

Yazdi AP, Mashhadi L, Gilani MT (2019) Postoperative Delirium in a Patient Following Laparoscopic Cholecystectomy and Spinal Anesthesia. Int J Crit Care Emerg Med 5:076. doi.org/10.23937/2474-3674/1510076

Copyright

© 2019 Yazdi AP, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

CASE REPORT | OPEN ACCESSDOI: 10.23937/2474-3674/1510076

Postoperative Delirium in a Patient Following Laparoscopic Cholecystectomy and Spinal Anesthesia

Arash Peivandi Yazdi1, Leila Mashhadi2 and Mehryar Taghavi Gilani1,3*

1Associate Professor, Department of Anesthesia, Lung Diseases Research Center, Mashhad University of Medical Sciences, Iran

2Assistant Professor, Department of Anesthesia, Lung Diseases Research Center, Mashhad University of Medical Sciences, Iran

3Department of Anesthesia, Imam-Reza Hospital, Baharstr, Mashhad, Iran

Abstract

Delirium is one of the postsurgical complications in the geriatric population. Its incidence was reported up to 65% following major operations, and it is accompanied with high cost, morbidity and mortality. A 65-year-old man candidate for laparoscopic cholecystectomy under spinal anesthesia. His hypertension was under control with captopril 50 mg daily. In the middle of the surgery, he had cardiac arrest and cardiopulmonary resuscitation was performed. Vital signs improved within 6 minutes, but he was unconscious after operation. Patient was transferred to ICU and was treated for metabolic changes, hemodynamic instability and midazolam or haloperidol for agitation and restlessness symptoms. Blood tests, ECG, brain scan, and MRI were reported normal. Patient had impaired consciousness for 8-9 days, and he was discharged from the hospital in good physical status and totally conscious state on day 12. Patient suffered chest pain and died 4 days later. Postoperative delirium can be predicted in this patient considering all risk factors; male gender, advanced age, cardiac arrest, hemodynamic disorder, and admission in ICU are some of the predisposing risk factors. Treatments included removing intensifying stressors, treating risk factors, limited use of tranquilizers, pain control and finally using antipsychotics like haloperidol for aggressive behaviors.