The Journal of Thoracic and Cardiovascular Surgery, Vol 70, 717-726, Copyright © 1975 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Postoperative psychosis after heart surgery
IS Sveinsson
One hundred heart surgery patients were followed throughout their
postoperative periods to assess the incidence and etiology of
postcardiotomy delirium. Factors evaluated were: age, sex, history of
previous psychiatric illness, history of cerebrovascular disease, cardiac
diagnosis and operation, time of anesthesia, time of bypass, time spent in
the intensive-care unit, and amount of sleep during the postoperative
period. Six patients developed delirium, five of whom had a lucid
postoperative interval; four patients had perceptual disturbances only,
without loss of contact with reality; three had neurological symptoms with
mild confusion; 87 kept a clear mental state. The following factors tended
to be related to the occurrence of delirium and perceptual disturbances:
history of preoperative psychiatric illness, advanced age, severity of
preoperative and postoperative illness, and time spent in the
intensive-care unit. Sleep deprivation consistently preceded onset of these
symptoms with one exception. Operative factors did not seem to be of major
importance. While postoperative delirium probably has multidetermined
causes, the author believes that sleep deprivation superimposed on the
other contributory condition is a common precipitating factor. Suggestions
about the prevention and treatment of delirium are made.
