Postoperative Delirium Developed After Open Prostatectomy Under Spinal Anaesthesia: A Case Report

Abstract

Post-operative delirium is seen after long-duration surgery such as vascular and orthopedic surgical procedures with higher incidence. Delirium is associated with higher post-operative mortality, morbidity and delayed functional recovery. Advanced age, post-operative pain and sleep problem were important factors for delirium. Therefore post-operative analgesia and good sleep can help to prevent post-operative delirium. The use of intraoperative regional anesthesia does not certain to decrease the incidence of post-operative deliryum when compared with general anesthesia. Neuroleptics such as haloperidol, droperidol and benzodiazepines are used in order to control symptoms like restlessness, agitation and altered perceptions. We aimed to discuss in this case post-operative delirium that developed after open prostatectomy and cystolithotomy under spinal anaesthesia.

Keywords

• -

Spinal Anestezi Altında Yapılan Açık Prostatektomi Sonrası Gelişen Postoperatif Deliryum: Olgu Sunumu

Öz

Post-operatif deliryum, vasküler ve ortopedik cerrahi gibi uzun süren prosedürler sonrasında yüksek insidansta görülür. Yüksek mortalite ve morbidite ile birlikte fonksiyonel iyileşmede gecikmeye neden olur. Deliryum için yaş, post-operatif ağrı ve uyku problemleri en önemli risk faktörleridir. Bu nedenli post-operatif analjezinin iyi düzenlenmesi ve uyku bozukluğunu düzeltilmesi deliryumun önlenmesine yardımcıdır. Genel anesteziye karşın intra-operatif rejyonel anestezinin post-operatif deliryum yapma olasılığının daha düşük olduğu önerilse de bu kesin değildir. Huzursuzluk, algılama bozukluğu ve ajitasyon benzeri semptomların kontrolünde haloperidol, droperidol gibi nöroleptikler ve benzodiazepinler kulanılmaktadır. Biz bu olguda spinal anestezi altında yapılan açık prostatektomi ve sistolitotomi sonrası gelişen post-operatif deliryumu tartışmayı amaçladık.

Anahtar Kelimeler

• -

References

1. 1. Parikh SS, Chung F. Postoperative delirium in the elderly. Anesth Analg 1995; 80: 1223-1232.
2. 2. Meral Ucuzal M, Akyolcu N. Yaşlı Hastalarda Ameliyat Sonrası Bilişsel Değişiklikler. Turkish Journal of Geriatrics 2008; 11: 119-127.
3. 3. Cavaliere F, D'Ambrosio F, Volpe C, Masieri S. Postoperative delirium. Curr Drug Targets 2005; 6: 807-814.
4. 4. Sieber FE. Postoperative delirium in the elderly surgical patient. Anesthesiol Clin 2009; 27: 451-464.
5. 5. Sieber FE, Barnett SR. Preventing postoperative complications in the elderly. Anesthesiol Clin 2011; 29: 83-97.
6. 6. Wu CL, Hsu W, Richman JM, Raja SN. Postoperative cognitive function as an outcome of regional anesthesia and analgesia. Reg Anesth Pain Med 2004; 29: 257-268.
7. 7. Williams-Russo P, Sharrock NE, Mattis S, Szatrowski TP, Charlson ME. Cognitive effects after epidural vs general anesthesia in older adults. JAMA 1995; 274: 44-50.
8. 8. Bryson GL, Wyand A. Evidence-based clinical update: general anesthesia and the risk of delirium and postoperative cognitive dysfunction. Can J Anaesth 2006; 53: 669-677.

9. 9. Tognoni P, Simonato A, Robutti N et al. Preoperative risk factors for postoperative delirium (POD) after urological surgery in the elderly. Arch Gerontol Geriatr 2011; 52: 166- 169.
10. 10. Morimoto Y, Yoshimura M, Utada K, Setoyama K, Matsumoto M, Sakabe T. Prediction of postoperative delirium after abdominal surgery in the elderly. J Anesth 2009; 23: 51- 66.
11. 11. Echigoya Y, Kato H. Postoperative complications after femoral neck fracture in advanced elderly patients. Masui 2008; 57: 163-166.
12. 12. Chen ZY, Chen YH, Zhu HB, Yang SK. Clinical analysis of postoperative delirium in elderly patients with benign prostatic hyperplasia. Zhonghua Nan Ke Xue 2007; 13: 411-413.
13. 13. Olofsson B, Lundström M, Borssén B, Nyberg L, Gustafson Y. Delirium is associated with poor rehabilitation outcome in elderly patients treated for femoral neck fractures. Scand J Caring Sci 2005; 19: 119-127.