A little less than three weeks ago, my father underwent TEVAR (endovascular) surgery on an emergency basis to repair an aneurysm in his upper aorta. The procedure lasted about 12 hours, and several stents and extensions were placed both at the aneurysm site and near the renal arteries. This was his second major cardiac intervention, as he underwent open-heart surgery (coronary bypass) about eight years ago.
The medical staff told us after the procedure that his recovery might be complicated, especially since he is a regular and fairly heavy drinker (though a highly functional one--he is a business owner and works six days a week) and they believed he would be going through alcohol withdrawals. A little over a week out of surgery he was extubated from the ventilator and breathing only with the assistance of oxygen through a nasal cannula. Once he was able to breathe more or less on his own and his vitals had stabilized, the doctors began treating what they have diagnosed as delirium tremens--not just post-operative delirium, according to what we have been told, but DT related to alcohol withdrawal--with diazepam and haloperidol.
We are told that his blood gas exchange, his volume and quality of respiration, his heart rhythm, and his blood pressure are all exemplary for someone who has been through such a crisis and a procedure--he has exceeded expectations in this regard, perhaps in part because the staff did not realize what a highly active person he was before the aneurysm.
However, ever since his extubation and the cessation of propofol sedation, he has been extremely fidgety, sometimes almost violently so, and continually causes problem because of pulling at catheters, the IV, and so forth. There is a lot of extrapyramidal activity. It is for this reason, we are told, that he is being treated with diazepam and haloperidol, and again we are told that this is because of the delirium tremens.
Currently he is being fed through a feeding tube and is on an IV and a urinary catheter. Over the past few days they have had to sedate him several times--sometimes with demerol, and on at least one other occasion with more propofol--because he has pulled out tubes, etc., and they have needed to fix the problems. He is no longer on diazepam, but is still being given haloperidol on an as-needed basis according to the psychiatrist's orders. This has been going on for roughly two weeks.
When Dad is awake, he is very definitely able to answer specific, high-level questions by nodding or shaking his head--questions like "Am I your brother?" to which he will shake his head "no." "Am I your son?" to which he will reply "yes," etc. "Would you like to watch the Home Shopping Network?" A violent headshake no. "How about Gunsmoke instead?" Yes indeed, et cetera. He also constantly tries to speak, but his speech is unintelligible, and he seems to realize this and be very frustrated by it.
My question is this: according to the experience of those of you who may have dealt with this kind of situation or something similar, is this protracted recovery with great physical progress but much slower mental progress at all normal? It seems paradoxical to me that the staff is keeping him heavily medicated to prevent him from pulling out tubes, et cetera--with this medication, it seems certain, at least somewhat slowing his return to normal consciouness--but seem much less concerned with actually getting him off the feeding tube, off the catheter, and so forth, after three weeks' time, so that his condition can be assessed? He is able to respond to instructions, and able to eat ice chips slowly and carefully--which is all we are allowed to give him by mouth at the moment.
I'm just curious to get some educated input, because while we have been happy with his treatment so far, we also feel that we are getting some mixed information regarding how much of his current state is due to alcohol withdrawal vs. the actual surgery recovery, and we have gotten few definite answers as to why the recovery is taking so long, if it is abnormal in any major respects, and exactly what the plan is for the coming days. Any input at all is appreciated, and if I can clarify anything further, I will certainly try to do that. Thanks very much.
did your father recover?
did the hospital screen your father for alcoholism using the CIWA-ar scale? the Audit-PC? Ricker Sedation Agitation (SAS) Scale? toxology screening to include blood mangesium level, blood phosphate, comprehensive metabolic panel?
did they preform an ECG? EEG?
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