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Delirious Consciousness Delir After surgery many people are apathetic
The patient just seemed completely in his senses - but suddenly he seems apathetic, confused and can no longer say why he is actually in the hospital. This scenario is typical of a so-called "delirium", which can occur after surgery. The exact causes of the disturbance of consciousness have not yet been elucidated, but it is believed that e.g. A high age as well as pre-existing conditions like diabetes or hypertension increase the risk. If the malfunction is not detected in time, severe consequential damage or, in the case of an emergency, the death of the patient may be imminent.
Perception disorders and limitations of consciousness
Anyone who has an operation fears that something might happen during that time. Because complications can always occur. What, however, only a few know: Even after the procedure, the danger is not yet banned, because under certain circumstances, can develop a so-called "delirium". This is an acute state of confusion, which, if untreated, can lead to massive consequential damage. The disorder can occur directly after waking from anesthesia, but also only a few hours or days after the operation.
Many older people experience a state of great confusion after surgery. (Image: pressmaster / fotolia.com) Delirium can lead to death if left untreated
The term "delirium" originally comes from Latin, where "de lira ire" means "to deviate from the straight line" or "to go out of the lane". This describes the condition quite well, because sufferers are disoriented and can e.g. Do not tell me if it's morning or evening. They can not explain why they are in the hospital. Sometimes they are apathetic, others turn around, appear euphoric or aggressive. Likewise, despondency and timidity are possible. Disturbances of perception in the form of visual hallucinations, psychomotricity or the sleep-wake rhythm are also typical. Delirious people often can not sleep at night, which worsens their symptoms and causes extreme drowsiness and drowsiness during the day.
If the delirium is not recognized, permanent damage such as e.g. Concentration problems and limited mental performance. Patients are sometimes no longer able to read a book, "some do not even dare to leave the house because they have lost their orientation," says Claudia Spies, chief physician of the anesthesiological clinic, the news agency "dpa". Accordingly, if there were no treatment, severe complications in the cardiovascular system and respiration would be possible, which in the worst case could even be fatal. "Mortality increases with every undiscovered day," continues the doctor.
Up to 80 percent of elderly patients affected
If a patient is confused after an operation, the caregiver Christoph Schubert accordingly ensures the highest alert and he must immediately check whether a delirium exists. Schubert works at the Charité Clinic for Anaesthesiology in Berlin, where doctors and nurses are particularly concerned with the disorder. According to recent reports, up to 80% of older people in intensive care units are affected by the "dpa" report. Accordingly, at the beginning of each shift, Christoph Schubert and his colleagues check whether everything is alright for the patients. For this they use the so-called "Cam ICU test", which makes it possible to detect a state of confusion. The patients have to When recognizing each "A" in the word "pineapple tree," press the nurse's hand. If there are problems in perception or attention, the skilled personnel can quickly recognize this and act accordingly.
The exact trigger for the emergence of a "postoperative delirium" are not yet fully understood. Experts, however, assume that several factors play together and a high age of the patient as well as pre-existing conditions such. Diabetes or high blood pressure can increase the risk. According to the head physician Spies, inflammation in the body also plays a role in the development, which, according to various expert opinions, could possibly result from mental stress, major surgery or too little fluid. "Pain also causes inflammation," adds Spies. In 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 in delirium, the carers are usually required first. Christoph Schubert try the "dpa" report that no fear arises in the person concerned. It is often helpful if a relative comes to the hospital, said Schubert. The goal is that people feel comfortable in the intensive care unit. In order to be able to offer the patient immediate orientation after waking up from anesthesia, e.g. always with the glasses ready, also the regular naming of the date or a clearly recognizable clock could offer good support.
As a relative it is important to have a lot of patience and not "talk away" the disorder, Spies emphasizes. Fears of surgery could be e.g. be reduced by enlightening conversations, because "patients are always afraid," said the doctor on. "We have to be honest with the patients," says Spies.
According to the German Federal Office of Statistics, just under 42,000 in-patient cases of delirium were registered in 2014, 2,000 more than in the previous year. Not included here are the disturbances of consciousness that have occurred as a result of alcohol or drugs. There is no country-wide medical guideline for dealing with the state of confusion in Germany - accordingly, each hospital has its own specifications as to how to act in a delirium. In the United Kingdom, on the other hand, the "Delirium: screening, diagnosis and treatment" policy has been in place since 2010, the news agency continues. In Canada and the US, the so-called "Help Program" (Hospital Elder Life Program), which was developed in 1993 by the doctor Sharon Inouye and colleagues of the Yale University Medical School. It is a program for the prevention, diagnosis and treatment of delirium, which should improve the hospital care of the elderly. In this country the evangelical hospital Bielefeld (EvKB) is according to own data the first hospital in Germany, in which patients profit from the program. (No)