special subjects
Postoperative Care
Mental status
All patients are briefly confused when they come out of anesthesia. Older patients, especially those with dementia, are at risk of postoperative delirium, which can delay discharge and increase risk of death. Risk of delirium is high when anticholinergics are used. These drugs are sometimes used before or during surgery to decrease upper airway secretions, but they should be avoided whenever possible. Opioids, given postoperatively, may also cause delirium, as can high doses of H2 blockers. The mental status of older patients should be assessed frequently during the postoperative period. If delirium occurs, oxygenation should be assessed, and all nonessential drugs should be stopped. Patients should be mobilized as they are able, and any electrolyte or fluid imbalances should be corrected. 