Acute Postoperative Delirium and Extrapyramidal Signs in a Previously Healthy Parturient

An unusual case of emergence delirium

“…The etiology of delusion in the postoperative period is multifactorial. 2 Contributing factors include certain drugs, including ketamine, neuroleptics, hallucinogens, and anticholinergics; withdrawal syndromes such as from alcohol, barbiturates, cocaine, opiates, and benzodiazepines; underlying central nervous system disorders, such as dementia, parkinsonism, and alcoholic brain syndrome; cerebrovascular insufficiency, such as from peripheral vascular disease, hypoxia, carbon monoxide poisoning, severe anemia, hypotension, and decreased cardiac output states; metabolic and endocrine factors, such as uremia, hepatic encephalopathy, adrenal insufficiency, hypoglycemia, hyponatremia, and hypercalcemia; preexisting psychiatric illnesses, such as underlying psychosis or neurosis, endogenous depression, phobic states, and personality disorders; postoperative pain; bladder and bowel distention; and extremes of age. 2 We present a case of emergence delirium following an uneventful endoscopic sinus surgery and discuss a potential mechanism.…”

Postoperative opisthotonus and torticollis after fentanyl, enfiurane, and nitrous oxide

“…However, a toxicology screen was not performed on our patient or in any of the other reported patients with movement disorders. [1][2][3][4][5][6][7][8][9][10][11] Myoclonus is characterized by either irregular or rhythmic muscle jerks, and it can either be epileptic or nonepileptic. Our patient's symptoms were not felt to be characteristic of seizures, due to EPS symptoms and periodic apnea.…”

“…[6][7][8][9][10][11] One case of myoclonic, postoperative symptoms has been reported after enflurane. However, the patient had focal symptoms, with right-sided headache and otalgia, a subjective feeling of left-sided weakness, persistence of myoclonus for 48 hr, with no definite exclusion of CNS pathology.…”

Some unusual forms of early onset postpartum psychosis

“…Severe blood loss (Weiskorn 1897) may have been a factor in one, and anaesthetics or other drugs (Manton 1892; Bourson 1958; Weinger et al 1988; Davis et al 1996) in four cases. As for frequency, Neubürger (Kirchberg 1913) had seen only case of this kind in 3160 births, and Engelhard (Engelhard 1912) had one possible case in nearly 20,000 deliveries.…”