Elderly DF hysterical after surgery

[Butterflytoast123]

DF (87) had an operation under general anaesthetic which went very well (according to the surgeon). However ever since he has been hysterical, screaming and shouting everyone taking care of him things like "I'm dying" "kill me". He is on low dose antidepressants which aren't helping much. The nurses called in a psychiatrist who concluded that he knows himself but depressed, prescribed melatonin. Would anyone have any advice to make him a bit more comfortable? It's very difficult and distressing to witness. He is pretty much not sleeping and constantly screaming, not interacting with any of us much apart from that. I miss my DF.

Seems like he may have had a bad reaction to the general anaesthetic. May improve with time

Did he lose a lot of blood during the op?
Low iron can cause anxiety and depression. It doesn’t even have to be low low, if he’s in the lower end of normal range it could have an effect. Also low Vit D, B12/ folate can all have similar symptoms.

Anemia contributes to altered brain neurotransmitter homeostasis through poor brain myelination and impaired monoamine metabolism. These alterations in the brain's homeostatic mechanisms can lead to emotional and psychological problems predisposing to depression diagnosis

How long ago was the surgery? It may be a reaction to the drugs. Have they checked for a uti - it can often cause symptoms like this in the elderly.

ask about post op delerium.

I have a theory that's not borne out by anything other than personal experience and anecdotal stuff from others, about GA driving people into dementia. I know (or have heard of) several elderly people who, following a GA, have descended into full blown dementia, having shown either no, or very few, signs of cognitive decline previously.

Post-operative delirium (POD) or generic hospital delirium would be my first thought.

Have they checked for UTI?

My FIL had post op delerium last year after major abdominal surgery. DH and his sister ended up having to take turns to stay over to calm him down overnight. He improved at around day 5 and was home and back to normal by day 10. It's apparently more common in older men after major surgery.

Yes, this was my Mum after they repaired her broken hip under GA. Although the operation went well and she recovered physically, I don’t believe she ever recovered properly from being under the anaesthetic. It marked the start of her cognitive decline and was the beginning of the end 4 years later.

Post op delerium? When was the surgery?

I'd go for post op delirium too, or a reaction to opiate painkillers as a combination - my mum was thrown totally by the combination of a GA and opiates for a couple of weeks. She did have very early dementia then, and she didn't get back to where she was before. Later on she had another GA, and that was awful in the effect on her mental state.

My MIL had this - op went well but she was convinced that she was being kidnapped afterwards and had to have 24/7 supervision for several days. She recovered well over the next few weeks. She is much more anxious since then but cognitively all there.

My dad had a massive op about 6 years ago, really serious and he had post anaesthetic delirium for several days. One morning he told us how he and the man sharing his room has escaped down the wall and been to the pub. Another sad but memorable day he was utterly convinced I had been killed in a car crash and could not be persuaded otherwise until I turned up.

hopefully this accounts for your dads confusion.

Not sure what you mean by “according to the surgeon”?

Sounds like post op confusion. Give him a day or two to recover. GA is no walk in the park at 87.

Definitely sounds like he's got delirium which is very common in the elderly when they are hospitalised. Please speak to his doctors.

My mum had some things similar when she had a broken hip. I spoke to the doctors and they said it's absolutely normal.

My Dad had this, talking absolute nonsense for a few days which was not like him at all, but he recoveredquickly thankfully. Hope yours does too.

there is a spectrum of post operative cognitive changes that can occur with older folk having surgery (it's the whole package of the physiological stress response to surgery and anaesthetic, and isn't just 'the GA'). Once other immediate causes (like a full bladder, low blood sugar, infection, severe pain etc.) have been excluded then post op delirium/cognitive dysfunction is probably the most likely cause and management is usually supportive (and may include antipsychotic medication if non-pharmacological things aren't enough). Another thing that happen surprisingly often & may be worth considering is alcohol withdrawal (esp on day 3 of not drinking... and an octogenarian doesn't need to be drinking that much to experience this). Surgery can unmask a fragile brain, and while it's not thought to cause dementia, it may accelerate a process that was already subtly happening.

Thank you for your messages. His doctor wanted to make a start with a melatonin supplement, which gave him a longer stretch of sleep last night. He is still in a bad mood but speaks more reasonably. The surgery was only 5 days ago, so I'm hopeful he will improve even more.