Postoperative Delirium Following Orthognathic Surgery in a Young Patient.
Delirium is an organic mental syndrome with acute onset characterized by diffuse brain dysfunction and neural activity disorganization. It is usually related to cognition and perception changes, decreased level of consciousness, and disorganization of thoughts that are unrelated to previous dementia. Occurrence is more frequent in patients with previous degenerative disease and elderly patients, especially those older than 85 years. Although the pathophysiology is not totally known, studies have shown that, among the main factors that lead to delirium, the drugs used for general anesthesia induction are the most relevant (hypnotics, anticholinergic drugs, and H2receptor blockers), especially those used in long surgical procedures. This report describes the case of a 24-year-old woman with a noncontributory medical and psychological history. She underwent bimaxillary orthognathic surgery with a total general anesthesia time of 7 hours. Postoperatively, she developed agitation, confusion, and delirium. After a psychiatry consult and discussion with the anesthesia team, the diagnosis of psychotic break owing to late postoperative delirium was established.
Surgeon, Department of Oral and Maxillofacial; MSc Student, Department of Oral Pathology, State University of São Paulo, São Paulo, SP, Brazil. Electronic address: fer_odontouel@hotmail.com.
Fernanda Herrera
FH
da Costa
Private Anesthesiologist, Hospital Evangélico de Londrina, Londrina, PR, Brazil.
Paulo Adilson
PA
Herrera
Associate Professor, Department of Oral Medicine and Pediatric Dentistry, State University of Londrina, Londrina, PR, Brazil.
Cecília Luiz
CL
Pereira-Stabile
Adjunct Professor, Department of Oral Medicine and Pediatric Dentistry; Coordinator, Residency in Oral and Maxillofacial Surgery, State University of Londrina, Londrina, PR, Brazil.
Glaykon Alex
GA
Vitti Stabile
D003693:Delirium / Q000209:etiology*; D005260:Female; D006801:Humans; D008312:Malocclusion, Angle Class II / Q000150:complications / Q000601:surgery; D056948:Orthognathic Surgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D055815:Young Adult