Thursday, March 5, 2009

Confusion after anesthesia

I took care of an older gentlemen who had a laparascopic procedure and, upon wakening from anesthesia, became confused and combative and had to be restrained with soft wrist restraints. At post-op day two, when I was with him, he was still screaming and thrashing around—not combative, but wanting to pull off his cardiac monitor and IV and leave. Over the course of the day he became more lucid, then more confused. His main focus seemed to be the restraints, so at one point we took them off and he became quite calm...for about two hours. Then he went bonkers again, so the nurse restrained him.

The last patient I had who experienced confusion after anesthesia was a younger woman who had heart surgery. Day one after surgery she was fine (albiet groggy), but day two she was screaming, paranoid, thought we had arrested her, and throwing things. Post-op day three she was back to normal and didn't remember any of it.

And then there were the few patients who stroked during or after surgery, or seemed to have permanent mental status changes, or have other negative sequelae after anesthesia. One older patient I took as a care aide on the medical floor had been combative and tied to the bed after surgery, but had improved. When I got him up for physical therapy he threw a clot and had a pulmonary embolism. We coded him and he died later that day.

So with all this on my mind, I came home to find my daughter had received a new book: Gaspard in the Hospital. It's about a little dog who swallowed a keychain and had to be put under anesthesia to have it removed. During the anesthesia he dreams he's a race car driver, and when he wakes up his mom gives him a present. I explained anesthesia medicine to her, and ended with saying that you wake up fine. She looked at me and said "Always?" I said something like "Uuuhhyyyyeah." Probably not reassuring. But then again, don't kids do better than adults with anesthesia, and surgery in general? Something I should look into.

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