Clinical Case Database / Category: Patient Management

Post-operative delirium

Publication details

Rachael Dolan, Dr FA Levins MB, BS, FRCA, DEAA, DRCOG
Foundation Years Journal, volume 9, issue 9, p.27 (123Doc Education, London, October 2015)

Abstract

We present the case of an 84 year old female who had a fractured neck of femur and developed acute confusion following administration of opioids. Her confusion resolved but it posed a challenge for the anaesthetic team. Delirium is well defined and common in occurrence and a good understanding is required at all levels, across all specialties. This paper will look into more detail at the risk factors, clinical assessment and treatment of delirium. We shall also look at the specific anaesthetic challenge posed by this patient.

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Authors

Rachael Dolan

CT2 Anaesthetics
Department of Anaesthetics
Queen Elizabeth Hospital Birmingham
Mindelsohn Way, Edgbaston, Birmingham, B15 2WB
r.dolan@nhs.net

Dr FA Levins MB, BS, FRCA, DEAA, DRCOG (Corresponding author)

Consultant Anaesthetist
Department of Anaesthetics
Queen Elizabeth Hospital Birmingham
Mindelsohn Way, Edgbaston, Birmingham, B15 2WB
Andris.Ievins@uhb.nhs.uk

References

1. Deiner S, Silverstein JH. Postoperative delirium and cognitive dysfunction. British Journal of
Anaesthesia 2009, 103:141-46
2. Inouye SK. Delirium in older persons. New England Journal of Medicine 2006, 354:1157–65
3. Ely EW, Gautam S, Margolin R et al. The impact of delirium in the intensive care unit on hospital
length of stay. Intensive Care Medicine 2001, 27:1892–900
4. Moller JT, Cluitmans P, Rasmussen LS, et al. Long-term postoperative cognitive dysfunction in the
elderly: ISPOCD1 study. Lancet 1998, 351:857–61
5. Bellelli G, Morandi A, Davis DH, et al. Validation of the 4AT, a new instrument for rapid delirium
screening: a study in 234 hospitalised older people. Age and Ageing 2014, 0:1-7
6. Trzepacz P, Breibart W, Franklin J, et al. Practice guideline for the treatment of patients with
delirium. American Psychiatric Association. American Journal of Psychiatry 1999, 156:1-20
7. Jin F, Chung F. Minimizing perioperative adverse events in the elderly. British Journal of Anaesthesia
2001, 87:608-24
8. Inouye SK, Bogardus ST Jr, Charpentier PA, et al. A multicomponent intervention to prevent delirium
in hospitalized older patients. New England Journal of Medicine 1999, 340:669-76
9. Lundstrom M, Olofsson B, Stenvall M, et al. Postoperative delirium in old patients with femoral neck
fracture: a randomized intervention study. Aging Clinical and Experimental Research 2007, 19:178-86
10. Kalisvaart KJ, de Jonghe JF, Bogaards MJ, et al. Haloperidol prophylaxis for elderly hip-surgery
patients at risk for delirium: a randomized placebo-controlled study. Journal of American Geriatrics
Society 2005, 53:1658-66
11. Jacobi J. Clinical practice guidelines for the sustained use of sedatives and analgesics in the
critically ill adult. Critical Care Medicine 2002, 30:119-41
12. Han CS, Kim YK. A double-blind trial of risperidone and haloperidol for the treatment of delirium.
Psychosomatics 2004, 45:297-301
13. Robinson T, Eiseman B. Postoperative del

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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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