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ANESTHESIA ALERT
In the outpatient surgical space, orthopedic, breast, abdominal and eye
surgery all present high risk of delirium. Surgical risk factors include the
length of surgery, large blood loss (OR 1.6/1000cc), glucose that hits <60
or >300mg/dL, sodium levels <130 or >150mEq/L, or potassium at <3.0
or >6.0mEq/L.
Rest pain post-op increases risk of delirium. Type of anesthesia
(regional, general or combined) appears to have little effect on incidence
of delirium. Post-operatively, use of meperidine, long- and short-acting
benzodiazepines, anticholinergics and other narcotics seem to predict
development of post-op delirium. Of all these factors, age is among the
strongest predictors of delirium (see "Aging's Impact on Post-Op
Delirium"); history of psychiatric illness is No. 1.
Prepare your patients
Patients experiencing delirium after surgery may be agitated, or may
appear calm. Further, elderly patients tend to exhibit reduced auditory verbal learning, so oral instructions alone may not be enough, and
you may want to reiterate points to ensure full comprehension. If you
can, work with patients' other physicians to simplify medication regimens temporarily post-op. Make sure that patients and, in particular,
their caretakers understand the importance of early ambulation, fluid
and electrolytes intake, and pre-empting post-op pain.
It's important to remember that, when anyone undergoes surgery,
we're exposing the brain to the stress of anesthesia and surgery, and to
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | J A N U A R Y 2013
