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post surgical hallucinations and severe disorientation

  My brother (age 46), agreed to quintuple bypass surgery after a stress
  test and angiogram.  A 'leaky' valve was also revealed by the angiogram.
  But at the time of surgery it was decided it wasn't that bad so nothing
  was done with the valve.
  Successful surgery was performed last week on January 7, 1999.  His
  girlfriend reported that the first day after surgery he was "in and out"
  but when he was in, he was alert. (Pain medication was morphine, every
  three hours.)
  Day two and three: he was not awake for more than five or ten minutes
  at a time, and was described as being very out of it -- sleeping with
  his eyes open, or with one eye open and one closed, not knowing where
  he was and things like that. (Pain medication on day two was 1/2 of
  the morphine from day one.  Day three he was switched to Percoset upon
  request and was going 4-6 hours before asking for medicine.)
  Day four: he was more alert and conversational, but he still didn't
  know where he was or what they did to him. AND he began having severe
  hallucinations: bugs and animals on the wall, reporting that the
  clock and calendar on the wall were moving around, things like that.
  (Pain medication: percoset upon request, 4-6 hours.)
  *His girlfriend requested a neurological evaluation, and the neurologist
  visited at 11 PM and left a note saying he thought the 'episodes' were
  transient and the possible result of medication and being 'out of his
  Day five: He was much more alert, but still suffering from confusion --
  not knowing where he was, what they did to him, stating he was cut
  down the back.  He tried to physically pry off a calendar that was
  bolted to the wall.  Still, they released him from the hospital and he
  went home with his girlfriend. (Pain medication: vicadin as needed.)
  Day six: (today) I've spoken with him on the phone and while he is
  lucid about somethings, he's still delusional about others -- ie: he
  thinks the neighbors are watching him from the roof, a siren in the
  middle of the night made him think the house was on fire and they had
  to go outside before he would relax.  He still says he doesn't know
  what they did to him.  He opened his robe
  and exposed himself to a female friend of his girlfriends to show her
  his scar.  When his girlfriend said, you're flashing.  He just said,
  I know.
  The doctors just seem to say that it might be medication... or it
  might be the stress of the surgery.  They don't seem to know anything
  definitive.  His girlfriend doesn't feel like she can safely leave
  him alone in the house.
  My question is -- is this normal?  Or if not normal, something that has
  been known to happen?  And if it's something that will 'go away' --  
  how long will it take for it to go away?  
  This is really disruptive behavior for the girlfriend to deal with.
  I even suggested that she keep a journal in order to pin it down to
  a pattern and she said it's pretty much like this all day.
  Sorry this is such a long message, but I wanted to give the complete
Dear Sheryl,
Thank you for your question.  Post bypass confusion is unfortunately a potential complication of the surgery.  The reasons for this are multifactorial.  Narcotic pain medications, sleep deprivation,  and time spent on the heart-lung bypass machine are all possible reasons for confusion following surgery.  Most of the time this improves over time and the person returns to baseline.  Your brother will need close follow-up with his doctor and possibly additional neurologic follow-up as warranted.  
I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.

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