Post-Op Delirium

Question 1

What is delirium?

Answer 1

An acute confusional state, characterised by disturbed consciousness and reduced cognitive function

Question 2

Is delirium a common post-op complication?

Answer 2

Yes

Question 3

In what % of the elderly population does post-op delirium occur?

Answer 3

Around 15%

Question 4

What are the main types of delirium?

Answer 4

• Hypoactive
• Hyperactive
• Mixed

Question 5

What is the most common type of delirium?

Answer 5

Hypoactive

Question 6

What is hypoactive delirium characterised by?

Answer 6

• Marked lethargy

- Reduced motor activity

Question 7

What is hyperactive delirium characterised by?

Answer 7

• Agitation

- Increased motor activity

Question 8

What is mixed delirium characterised by?

Answer 8

Fluctuations throughout the day

Question 9

What are the major risk factors for delirium?

Answer 9

• Age >65
• Multiple co-morbidities
• Underlying dementia
• Renal impairment
• Male gender
• Sensory impairment

Question 10

What are the common causes of post-op delirium?

Answer 10

• Hypoxia
• Infection
• Drug induced or drug withdrawal
• Dehydration
• Pain
• Constipation or urinary retention
• Endocrine abnormalities

Question 11

What infections most commonly cause post-op delirium?

Answer 11

• UTI

- LRTI

Question 12

What drugs most commonly cause post-op delirium?

Answer 12

• Benzodiazepines
• Diuretics
• Opioids
• Steroids

Question 13

What drug withdrawal most commonly cause post-op delirium?

Answer 13

• Alcohol

- BZNs

Question 14

What may be required in gaining a history for a delirious patient?

Answer 14

Collateral history from family members and nursing staff

Question 15

What are the key features to ascertain from the history of a patient with post-op delirium?

Answer 15

• Onset and course of confusion
• Symptoms of a possible underlying cause
• Co-morbidities and previous baseline cognition
• Previous episodes
• Drug history, including alcohol intake

Question 16

oops forgot one sorry

What endocrine abnormalities most commonly cause post-op delirium?

Answer 16

• Hyponatraemia
• Hypernatraemia
• Hypercalcaemia

Question 17

What can be used to quantify the current cognitive function of a patient?

Answer 17

AMT or MMSE

Question 18

What should be done when examining a post-op patient with delirium?

Answer 18

• Review observations and drug chart
• Look for any signs of infection or pain
• Check for signs of constipation or urinary retention
• Neurological examination

Question 19

Why is it important to do a neurological examination in patients with post-op delirium?

Answer 19

To rule out any sinister underlying neurological pathology, e.g. stroke or subdural haematoma

Question 20

What may be warranted in any post-op patient with confusion, in terms of investigations?

Answer 20

A ‘confusion’ screen

Question 21

What might a confusion screen include?

Answer 21

• Bloods
• Blood cultures and/or wound swabs
• Urinalysis and/or CXR
• CT head

Question 22

What bloods may be done in confusion screen?

Answer 22

• FBC
• U&Es
• Ca
• TFTs
• Glucose

B12 and folate levels may also be additionally requested

Question 23

How should post-op delirium be managed?

Answer 23

• Any identified cause of delirium should be treated appropriately
• Patients should be nursed in appropriate environment
• Encourage oral intake, provide analgesia, and monitor bowels

Question 24

What is an ‘appropriate environment’ for a post-op delirium patient?

Answer 24

• Quiet area
• Regular routines
• Clocks to orientate to time and place

Question 25

Describe the use of sedatives in a patient with post-op delirium?

Answer 25

Should be used sparingly on any acutely confused patient, but if required, use haloperidol first line