Editorial  |   February 2019
Everyone Wants to Be Clear-headed When They Leave the O.R.
Author Affiliations
  • N. Martin Giesecke, M.D.
    Editor, ASA Monitor
Article Information
Central and Peripheral Nervous Systems / Geriatric Anesthesia / Editorial
Editorial   |   February 2019
Everyone Wants to Be Clear-headed When They Leave the O.R.
ASA Monitor 2 2019, Vol.83, 6-7.
ASA Monitor 2 2019, Vol.83, 6-7.
In their article “ASA Perioperative Brain Health Initiative: Engaging Others and Closing the Gap,” Drs. Peden and Fleisher share with us an update on the ASA Perioperative Brain Health Initiative (PBHI). They mention that, in patients older than 65 years of age, delirium is the most common postoperative complication. Delirium is part of the spectrum of perioperative neurocognitive disorder (PND), which also includes postoperative cognitive dysfunction (POCD). PND can occur in younger patients as well, and it is often mediated by medications that we may use in the O.R.
Twenty-two years ago, at the age of 37, your editor was skiing in Whistler, British Columbia. On those slopes, my skis became crossed in an icy section of snow, and my right knee was hyperextended when the binding on my right boot did not release. Needless to say, my right anterior cruciate ligament was torn in two. One of my colleagues gave me a great epidural anesthetic for the ACL reconstruction. I also received a propofol infusion because apparently I was asking the surgeon too many questions as he was doing the procedure. For postoperative pain control, my associate gave me an epidural injection of morphine prior to removing the epidural catheter. Though my mentation was initially clear, as the morphine was absorbed, I began hallucinating, seeing insects (which I really think are pretty interesting creatures) crawling on the walls and ceiling. I also had some relatively vivid dreams, waking myself up, to the surprise of my wife and another visiting colleague, with the acknowledgment “the lidocaine has been given!” prior to the release of the aortic cross-clamp in my dream.
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