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Old 05-28-2012, 09:40 AM   #1
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Post Sugical Dementia

My heart is quickly breaking.....my father 77 years old had open-heart surgery, triple bi-pass last Thursday. Physically, the surgery was successful. On Friday morning he was responsive, coherent and recognized my mom. He even sat up in the chair, ate lunch and had a conversation. He complained that his chest was hurting so they gave him morphine. That night he was out of his mind; confused, hallucinating, combative, aggressive and no longer knew my mom or even knew that I was in the room. Then they gave him two sedations to calm him down and make him sleep. Today, Memorial Day, he can barely stay awake, is still confused, doesn't know where he is, hallucinating, can't sit up for any length of time. He has been back on an IV for nutrition since Friday because he can't eat. He complains of dry mouth and keeps moving his mouth and lips in strange disfigured ways.

He now believes that everybody is try to kill him and he keeps trying to get out of bed and leave. Does anybody have any words of wisdom? Is this permanent? Prior to the surgery he was mentally very alert, brilliant and loved to discuss current affairs, will he every come back?

Signed,
Hopeless

 
Old 05-28-2012, 09:50 AM   #2
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Re: Post Sugical Dementia

Since he was fine right after the surgery, I'd say it's the morphine. I've only had demerol once (synthetic morphine) and I hallucinated like crazy on that stuff. Maybe they could try something else?

 
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Old 05-28-2012, 11:14 AM   #3
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Re: Post Sugical Dementia

Sometimes this happens after heart surgery, and to people who are younger as well.

It could definitely be drug interactions, drug side effects, and also just the fat that open heart surgery patients sometimes have this occur after surgery often depending whether it was "on pump" or "off pump".

In the cases I have known personally, they both came back fine after a few weeks or months. The one fellow went quite nuts for the first few weeks (delusions, paranoia, everyone trying to kill him, thought he was a pilot, aggressive, tried to escape from the hospital, etc etc etc) and then was forgetful and a bit "odd" for a few months after. The other became depressed and nasty for a few weeks and then bounced back.

It was hard to live with it for a while but their wives were forewarned and knew what to expect.

By all means address your concerns directly with your father's doctor. If he doesn't seem concerned or does not have answers for you then follow up with other specialists.

Also so some research online and you will quickly find cases of this described.

But everyone is different and talking honestly with the doctor is the first course of action.

Quote:
Originally Posted by emotional75 View Post
My heart is quickly breaking.....my father 77 years old had open-heart surgery, triple bi-pass last Thursday. Physically, the surgery was successful. On Friday morning he was responsive, coherent and recognized my mom. He even sat up in the chair, ate lunch and had a conversation. He complained that his chest was hurting so they gave him morphine. That night he was out of his mind; confused, hallucinating, combative, aggressive and no longer knew my mom or even knew that I was in the room. Then they gave him two sedations to calm him down and make him sleep. Today, Memorial Day, he can barely stay awake, is still confused, doesn't know where he is, hallucinating, can't sit up for any length of time. He has been back on an IV for nutrition since Friday because he can't eat. He complains of dry mouth and keeps moving his mouth and lips in strange disfigured ways.

He now believes that everybody is try to kill him and he keeps trying to get out of bed and leave. Does anybody have any words of wisdom? Is this permanent? Prior to the surgery he was mentally very alert, brilliant and loved to discuss current affairs, will he every come back?

Signed,
Hopeless

 
Old 05-28-2012, 12:40 PM   #4
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Re: Post Sugical Dementia

I agree with Suzy. My Dad also had open heart surgery (5 bypasses) and came through well but then had some confusion which went away in a couple of weeks. My money is on the morphine and sedatives. The morphine was the cause of Dad's craziness after his gall bladder surgery and the IV Ativan sent him into another period of hallucinations after a fall. Hallucination were prominent and later confusion which also went away in time. I do the same thing on any type of morphine based medication.

Suzy is right, please address these concerns with his physician and see if he could explain the behavior related to the surgery and possibly change the medication....

Love, deb

 
Old 05-28-2012, 01:22 PM   #5
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Re: Post Sugical Dementia

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Originally Posted by Gabriel View Post
I agree with Suzy. My Dad also had open heart surgery (5 bypasses) and came through well but then had some confusion which went away in a couple of weeks. My money is on the morphine and sedatives. The morphine was the cause of Dad's craziness after his gall bladder surgery and the IV Ativan sent him into another period of hallucinations after a fall. Hallucination were prominent and later confusion which also went away in time. I do the same thing on any type of morphine based medication.

Suzy is right, please address these concerns with his physician and see if he could explain the behavior related to the surgery and possibly change the medication....

Love, deb
Do you think dementia patients are prone to post-sedation delirium?

 
Old 05-28-2012, 01:36 PM   #6
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Re: Post Sugical Dementia

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Originally Posted by Luau View Post
Do you think dementia patients are prone to post-sedation delirium?
It is a complicated situation. Yes, if someone with dementia diagnosed has surgery, he will be affected by the surgery and may have delusion and get very anxious. It is possible that the dementia could show after a major surgery. It is hard to say. On the other hand, it is possible for someone normal who had surgery to come out with dementia due to the anesthesia issue.

In this case, Emotional75, you need to talk to the doctor to remove the possible elements/causes and see what is going on. It is also possible that Dad has dementia hidden, but it is hard to say for sure what happened unless the doctor tries to eliminate all the possible causes.

Regards,
Nina

Last edited by ninamarc; 05-29-2012 at 09:58 AM.

 
Old 05-28-2012, 02:11 PM   #7
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Re: Post Sugical Dementia

Luau... YES! Many have witnessed or suffered with it... even when the medical community denied it. Recently there have been some studies which proves that it does happen. It is more prevalent with some types of anesthesia. Because of this many surgeons are now only recommending necessary surgery. Mom's otho surgeon recommended not pinning Mom's broken hand for just this reason.

Yes, the hospital setting confusion and unfamiliarity, along with pain management med chances, and the whole experience can contribute to confusion in the elderly... but the post surgery delirium is possible as well ... just like hospital delirium

Love, deb

 
Old 05-28-2012, 02:42 PM   #8
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Re: Post Sugical Dementia

Quote:
Originally Posted by Gabriel View Post
Luau... YES! Many have witnessed or suffered with it... even when the medical community denied it. Recently there have been some studies which proves that it does happen. It is more prevalent with some types of anesthesia. Because of this many surgeons are now only recommending necessary surgery. Mom's otho surgeon recommended not pinning Mom's broken hand for just this reason.

Yes, the hospital setting confusion and unfamiliarity, along with pain management med chances, and the whole experience can contribute to confusion in the elderly... but the post surgery delirium is possible as well ... just like hospital delirium

Love, deb
Aside from stress from unfamiliarity, do younthink folks with dementia are generally more prone to additional altered cognition just because of the anesthesia? If so, do you think the additional impairment is transient, meaning they may return to the way they were after certain period of days/weeks?

 
Old 05-28-2012, 03:10 PM   #9
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Re: Post Sugical Dementia

Luau, yes and sometimes. The delirium can definitely be caused by the anesthesia. Sometimes cognition will return to their normal in time... but other times it does not. There are many I know of that have taken a very sharp and permanent decline downward as a result of anesthesia/surgery. This doesn't happen every time... but it is a definitely possiblity. Isoflurane, which is the most common anesthetic agent used. can cause the pathology underlying dementia in lab test on brain cells. It produced the same protein called beta-amyloid that crowds the brains of people with Alzheimer's. It seems to be more prominent in those who are genetically predisposed to Alzheimer's. So why not be a factor in those with Alzheimer's? There is current research to find the connections and implications of this agent as related to dementia and the delirium it cases after surgery. As I said... those that have experienced it have known there was a connection for years but science is just catching up

Love, deb

 
Old 05-28-2012, 09:39 PM   #10
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Re: Post Sugical Dementia

We believe my Mil's Dementia started from several surgeries over the years. Now no more surgeries she almost dis not come out of her last one. It was sevral days before she returned to consciousness.

As already stated. It is different for each person. My mil has a sleep apenea problem as well. When she sleeps with the machine at night she is much more coherent then when she does not. But still it is progressively getting worse.

Last edited by Charrev; 05-28-2012 at 09:40 PM. Reason: Left a word out so tired!

 
Old 05-29-2012, 06:55 AM   #11
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Re: Post Sugical Dementia

Dear Emotional75, we do hope that you are not feeling like we have hijacked your thread. What is happening to your father subsequent to surgery is truly nasty. Hopefully you can keep us updated on his progress? What he is suffering from is post-surgical delirium. Deliriums are temporary. I am understanding the real question on all of our minds is whether these delirium episodes will transition into dementia, which is non-reversible.

It seems what we are talking about is in a grey area of medicine. Nobody seems to know much, except anecdotal stories. Here is my anecdotal story: As many of you already know, my young DW has unmistakable signs of cognitive dysfunction with as yet undetermined etiology. She also is a Type 1 diabetic which predisposes her to frequent bouts of hypoglycemia. Some of these bouts are sufficiently severe that she losses consciousness. She has also had a number of major surgeries in the past 2 years that required general anesthesia. Especially in the last year or so, every loss of consciousness episode seems to be followed by another step downward in cognition. She recovers eventually, after a week or so, but rarely back to the same level as before the episode. The most recent was a colonoscopy last friday, which required a light general sedation. She hasn't been the same afterwards, behaving much more agitated, annoyed, and slower. Now I beginning to wonder if the anesthesia drugs or even the physical trauma of the procedures have anything to do with cognition decline at all. I am wondering if the true stressor is the actual event of loosing consciousness. Again, this story is strictly anecdotal.

Last edited by Luau; 05-29-2012 at 07:02 AM.

 
Old 05-29-2012, 07:47 AM   #12
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Re: Post Sugical Dementia

Luau, what you are seeing, I believe is real. Anesthesia is not a friend of dementia. The delirium can be real and for those with dementia they never seem to come back to their previous level after an bad episode. As Charrev said, sometimes it is a surgery that makes the dementia bad enough that we get it. When we think back pre surgery we an see very early symptoms but post surgery it all seems to get so much worse.

I also find this true with diabetic episodes, urinary tract infections, pneumonia, and any other major medical episodes. Just the stress of a change in routine, going to the hospital, ER, or rehab, sometimes can cause cognition changes.

Emotional... how is your father done?

Love, deb

 
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