• Matthew K Whalin, Matthias Kreuzer, Kevin M Halenda, and Paul S García.
• Department of Anesthesiology, Grady Memorial Hospital/Emory University, Atlanta, Georgia; Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia.
• Clin Ther. 2015 Dec 1; 37 (12): 2706-10.

PurposePostoperative delirium is a common and costly state of brain dysfunction that complicates postsurgical management in some patients. The purpose of this report was to describe a case of prolonged postoperative delirium and to review the appropriate identification and management of this condition.MethodsA 56-year-old female patient who presented with newly diagnosed diabetes mellitus and dry gangrene underwent a vascular bypass procedure while under general anesthesia. After extubation, the patient became disoriented and agitated.FindingsThe delirium continued in a hypoactive form for 10 days before it progressed to severe agitation. During the patient's 2-month hospitalization, she underwent 6 additional surgeries. Eventually, the delirium improved with the use of antipsychotic agents, and the patient was discharged to a skilled nursing facility.ImplicationsThis patient's history, medications, and anesthetic and surgical exposure placed her at high risk for postoperative delirium. Her exceptionally prolonged course of postoperative delirium was likely perpetuated by a multitude of factors, including the continued use of high-risk medications, the stress of repeated surgeries, urinary issues, and infection.ConclusionIn this high-risk patient, a proactive approach to the prevention and treatment of delirium may have avoided or mitigated the prolonged delirium and, potentially, long-term cognitive deficits.Published by Elsevier Inc.

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