Post Surgical Delirium?

Daughter of a Marine

Hi Friends - I'm reaching out for some guidance and direction.  My DH, diagnosed with mild dementia about 8 yrs ago, had extensive spinal surgery on 5/17, was under anesthesia for 5 hours and was given hydrocodone, muscle relaxants and early on, percoset and dilaudid (the latter 2 briefly) for pain.  He experienced hallucinations and extreme confusion and agitation to the point that he was unable to sleep, kept seeing things, having conversations with unseen people, etc. 

We stopped narcotic meds but he's still extremely forgetful and uncooperative with his recovery plan - keeps trying to do things he is not released to do (he is fused from L1 to S1).Today, he grabbed the car keys and said see later - going to get gas - He is NOT released to drive! When I object, he acts like I'm crazy and gets angry.   It's a constant battle and I'm at the end of my rope. My biggest fear is that this is actually progression of his dementia, though I am praying his body is still processing all the narcotics in his system (his dr said they can stay in fat cells for a few months) -  Any guidance/suggestions are very much appreciated - Thank you!

M1

Id be very doubtful that its the narcotics at this point DOM. Anesthesia though does weird things, especially when prolonged. Likely nothing for it but time-can you hire some help so that you can get some breaks?

JJAz

Much more likely to be caused by anesthesia.  Could take 2-3 months to see how much he recovers.

Ed1937

This thread seems familiar. My wife had spinal surgery in Feb. 2018. She developed AFIB during surgery, and was put on medication for it. Five days after being released, it was as if someone threw a switch. She did not know how to turn the lights on and off in the room, most of her speech was non sensible, among several other symptoms. The surgeon thought it might be due to the new medication. She quit taking it, and within a few days, she began to regain much of what she lost. The worst symptoms faded away, but she still retained some of the less severe symptoms, never to be regained. In June, she was diagnosed with VD. So was it due to medication interaction, or delirium? I think it was due to interaction.

Pam BH

My DH had what was referred to as a neurological reaction to medication 2 years before symptoms/diagnosis of AD and VD.  He fell and fractured a vertebra, no surgery. ER doc gave him valium and tramadol for pain. As Ed said his DW did, within 5 days he could not walk, nonsensical speech, seeing bugs and picking them off me, him, and in the air. Was hospitalized for 3 days but didn't return to normal for at least 2 weeks.  Strange thing is at the time I thought he was acting like someone with AD ,and lo and behold 2 years later he was diagnosed with it.  He's not at that stage yet but I think I've had a window into the future.  Best of luck to you. Hopefully the effects will wear off soon and he'll be back to his normal.

ElaineD

https://utswmed.org/medblog/postoperative-delirium-seniors-recognizing-symptoms-reducing-risks/

Postoperative delirium is common for seniors.

Elaine

Jane Smith

Hospital induced delirium is absolutely A Thing.  Anesthesia, narcotics, medication changes, the stress from the surgery, pain, the hospital atmosphere. It’s unfortunately not uncommon for older patients and especially persons with dementia. It can take time to get back to baseline. I went through this with my mother after she had to have surgery in the mid-stage of her dementia. It was not easy. 

Was he discharged from the hospital to a rehab facility or home?  If the latter, I’d bring in help ASAP or even consider placement in rehab or skilled nursing where he will have 24/7 supervision in a controlled environment (and you can get some sleep).

I hope you’re able to find a solution. Best wishes.

Jo C.

Oh my goodness; that must be a huge challenge to say the least.   With Medicare, if your DH was in the acute hospital for three 24 hour days, (the qualificatin period to get to rehab with Medicare coverage), he would qualify for rehab if his condition warranted it to return him to his usual function and need for medical supervision and need for progressive rehab.  This can be done within 60 days of having been discharged from the acute hospital after having served those three 24 hour days qualification period.

My step-dad had several weeks to a couple of months after his hospialization until he regained his old self again; but he did not have a surgery from where he could hurt himself.

If rehab would be considered, the doctor would have to order it and document:

1, The patiet requres rehab

2.  That the patiet requires continued medical supervision.

3. That the patient needs coordinated care with the doctor and therapists working together.

My concern from what you have written is that your husband is unfettered and may injure his spine and undo the benefits from his surgery.

Let us know how he is doing and how you are; I sure will be thinking of you.

J.