Expert: Ronald Levy, M.D. - 5/12/2008

Question
My mother had her second back surgery Friday and here it is Monday and she still is not awake and talking normally and her behavior is very much out of character.  I'm not there to talk to her doctors (I live in AL, she is in TX) but my sister tells me they are "perplexed".  I'm being told that she'll open her eyes but stares right through everybody or acts real agitated about something.  They say every now and then she'll come out of it and respond to someone rationally (like the lights will come on for a second or two) but for the most part she just lays there moaning while staring into space or starts screaming something crazy like "if she wins I'll just die!" and tries to fight (literally) with the nurses.  Could the anesthetics be to blame?  Could something have gone desperately wrong and damaged my mother?  Could this be just a temporary reaction to all the medications or trauma she's been through?   I'd appreciate it very much if you'd give your opinion and  advise on what we should do.

FYI…She has been on the morphine patch for at least two years now and there have been a time or two where she would become real spacey to the point that we were very concerned about Alzheimers.  But after my father changed her patch within minutes she was back to her old self again.  Now she's on a morphine drip so I'm thinking too much morphine may be the problem and once the amount is reduced she'll bounce back to her old self.  Does that sound feasible?  Thank you so much for your time.  Just writing this has been therapeutic for me.  I'll be anxiously waiting on a reply.
 
Thanks again,

Melody

Answer
I doubt the anesthestic is the problem but she should certainly be evaluated to make sure there is no organic reason for the problem (stroke, etc). I suppose it is possible that she is getting too much narcotic but if someone has been on narcotics chronically, they tend to have a much higher tolerance for them. She should also probably get a psych exam. They will be able to tell if this is a "Normal" hospital psychosis or something more serious. I don't think anything went "desparately wrong".

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston