Abstract

Postoperative delirium (POD) is a postsurgical complication that disproportionately affects older individuals and can be complex in its clinical presentation. The etiology of POD is often multifactorial, making diagnosis, consistent terminology usage, and treatment challenging. A 65-year-old man presented for a left carotid endarterectomy (CEA). His postoperative course was complicated by an episode of POD secondary to central anticholinergic syndrome (CAS), benzodiazepine use, underlying patient risk factors, or a combination of these potentially compounding variables. His medical history included an 80 to 90% occlusion of the left carotid artery, multiple transient ischemic attacks, hypertension, hyperlipidemia, depression, vertigo, anxiety, and 50 pack per year smoking history. After general anesthesia with desflurane, N2O, and endotracheal tube placement, the patient aroused combative, agitated, and delirious. He was treated with propofol 30 mg intravenously (IV), but his symptoms did not improve. He became increasingly agitated in the post-anesthesia care unit (PACU). He was treated with propofol 20 mg and midazolam 2 mg IV but remained combative and confused. Two doses of physostigmine 0.5 mg IV were administered, resulting in resolution of his symptoms. He was admitted to the intensive care unit for observation and was discharged the following morning without additional complications.

Author Details

John Patrick Haltom, DNP (c), RN

Sigma Membership

Unknown

Lead Author Affiliation

Samford University, Birmingham, Alabama, USA

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Observational

Research Approach

N/A

Keywords:

Postoperative Delirium, Physostigmine, Central Anticholinergic Syndrome

Advisor

Rankin, Heather

Second Advisor

Cahoon, Terri

Degree

DNP

Degree Grantor

Samford University

Degree Year

2021

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.

All permission requests should be directed accordingly and not to the Sigma Repository.

All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Proxy-submission

Date of Issue

2021-03-24

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