Many patients are confused and disoriented after surgery. That usually goes away again. But for some there is a specific reason – and then the nurses have to act quickly.
(Photo: Florian Peljak)
Some patients who wake up from anesthesia after an intensive care operation in our intensive care unit get strange: they are extremely restless, they get cold sweating, the whole body or parts of it tremble like hands, they speak incoherently and seem disoriented . In such cases I have strong suspicions which I check with a simple question to the patient: “Would you like a beer?”
It is a matter of experience to realize that these are withdrawal symptoms. Quite a few patients wake up confused after an operation. But that goes away again. The withdrawal cases, however, are different. We have to actively counteract this, because in the worst case it can be fatal.
For example, many years ago I had a patient who was severely alcoholic. Unfortunately, it took some time to find out because he had given false information about his consumption during the anesthetic talk before his operation. He slipped into severe delirium due to his withdrawal. We had tried everything in our power to save him – in addition to the drug treatment, we even ordered schnapps to interrupt the withdrawal. But it was too late: the man died.
This is of course an extreme example; in eight years in the intensive care unit, I have only seen one such case. Nevertheless, alcohol is an underestimated topic in the clinic. Time and again, patients conceal their true consumption during an anesthetic talk – probably because they are ashamed or they are not aware of the importance of absolutely correct information. As a result, medication is not optimally adjusted because alcoholism actually requires a higher dose. During an operation, this can lead to the patient waking up – the anesthesia is too weak. Fortunately, there are monitoring tools available so that anesthesiologists can prevent this from happening. But post-operative medication often does not work either, because the amount administered is simply too little. If in doubt, too high a dose is also dangerous – it can go wrong faster than you think.
It is not the case that we have a lot of alcoholics stumbling around in our ward. On the contrary: we may have a severely dependent person once every few months. It is much more common for older men between 70 and 80 who have been used to drinking two wheat beers in the evening for years. If this regularity suddenly breaks away in the clinic, it becomes noticeable – it does not take the habit of a daily bottle of whiskey to develop withdrawal symptoms.
When the patient now gets his half to drink – incidentally, something like this must always be prescribed by a doctor – then we can watch how he relaxes more with every sip. Only then can the body recover from an operation. And that’s why the patient actually came to us.
Julia Rettenberger is an intensive care nurse. In this column, the 27-year-old tells every week about her work at the district clinic in Ebersberg. You can find the collected texts at sueddeutsche.de/thema/Auf_Station.