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After the procedure, the brain is out of balance
The patient just seemed to be completely insane - but suddenly he appears apathetic, confused and can no longer say why he is actually in the hospital. This scenario is typical for a so-called "delirium", which can occur after an operation. The exact causes of the impaired consciousness have not yet been elucidated, but it is believed that e.g. old age and previous illnesses such as diabetes or high blood pressure increase the risk. If the malfunction is not recognized in time, serious consequential damage or even the patient's death may result.
Perceptual disorders and limitations in consciousness
Those who have an operation in front of them are usually afraid that something might happen during this time. Because complications can always occur. What, however, only a few know: Even after the intervention, the danger is not yet averted, because under certain circumstances a so-called "delirium" can develop. This is an acute state of confusion which, if left untreated, can lead to massive consequential damage. The disorder can occur immediately after waking from anesthesia, but also only a few hours or days after the operation.
Delirium can lead to death if left untreated
The term "delirium" originally comes from Latin, where "De lira ire" translates as much as "to deviate from the straight line" or "to get off track". This describes the condition quite well, because those affected are disoriented and can e.g. no longer say whether it is morning or evening. They cannot explain why they are in the hospital. Sometimes they are apathetic, others turn around, appear euphoric or aggressive. Depression and anxiety are also possible. Also typical are, among other things, disturbances of perception in the form of optical hallucinations, psychomotricity or the sleep-wake rhythm. Delirium sufferers often cannot sleep at night, which worsens symptoms and causes extreme drowsiness and dizziness during the day.
If the delirium is not recognized, permanent damage, e.g. Problems with concentration and a reduced mental performance. Some of those affected are no longer able to read a book, "some no longer dare to leave the house because they have lost their bearings," Claudia Spies, chief physician of the anaesthesiological clinic, told the news agency "dpa". Accordingly, if treatment is not given, serious complications in the cardiovascular system and breathing are possible, which in the worst case could even be fatal. "Mortality increases with every undiscovered day," continues the doctor.
Up to 80 percent of older patients are affected
If a patient appears confused after an operation, the nurse Christoph Schubert accordingly provides the highest level of alertness and he must immediately check whether there is delirium. Schubert works at the Charité Clinic for Anaesthesiology in Berlin, where doctors and nurses are particularly concerned with the disorder. As the "dpa" reports, up to 80 percent of older people in intensive care units are affected by this according to current studies. Accordingly, Christoph Schubert and his colleagues check at the beginning of each shift whether everything is OK with the patients. For this they use the so-called "Cam-ICU-Test", which makes it possible to recognize a state of confusion. The patients must e.g. when recognizing each "A" in the word "pineapple tree" press the caregiver's hand. If there are problems with perception or attention, the specialist staff can quickly recognize this and act accordingly.
The exact triggers for the development of a "postoperative delirium" have not yet been fully clarified. However, experts assume that several factors interact and that the patient's old age and previous illnesses such as Diabetes or high blood pressure can increase your risk. According to the chief physician Spies, inflammation in the body also plays a role in the development, which according to various specialist opinions could possibly be caused by psychological stress, major surgical interventions or insufficient fluid. "Pain also causes inflammation," adds Spies. With anesthesia, it is important to keep the right balance, because too many drugs could "unbalance" the brain.
Relatives need a lot of patience
If a patient is delirious, the caregivers are usually required first. Christoph Schubert tries the "dpa" report that no fear arises in the person concerned. It is often helpful when a relative comes to the hospital, says Schubert. The aim is that people feel comfortable in the intensive care unit. In order to be able to offer the patient orientation immediately after waking up from anesthesia, e.g. Always have your glasses ready, even giving the date regularly or a clearly recognizable watch could offer good support.
As a relative, it is important to have a lot of patience and not to "talk away" the disturbance, emphasizes Spies. Fears of surgery could e.g. can be reduced by educational talks, because "patients are always afraid," continued the doctor. "We have to be honest with the patients," says Spies.
According to the “dpa”, almost 42,000 inpatient cases of delirium were registered in 2014, 2,000 more than in the previous year, according to the Federal Statistical Office. This does not include the impaired consciousness that has occurred as a result of alcohol or drugs. There is no nationwide medical guideline for dealing with the state of confusion in Germany - accordingly, each hospital has its own guidelines on how to deal with a delirium. In the UK, on the other hand, the "Delirium: Precaution, Diagnosis and Treatment" policy has been in place since 2010, the news agency continues. In Canada and the USA, the so-called “Help Program” (Hospital Elder Life Program) is used, which was developed in 1993 by doctor Sharon Inouye and colleagues from Yale University Medical School. It is a program for the prevention, diagnosis and therapy of delirium, which is intended to improve hospital care for the elderly. In this country, the evangelical Bielefeld Hospital (EvKB) is the first hospital in Germany in which patients benefit from the program. (No)