Expert: Ronald Levy, M.D. - 3/3/2010

Question
43yr male, smoke 2ppd.had no other hx. had 2 vessel CABG 6 days ago. Long time waking then very combative upon waking, thrashing about, pulling out tubes. sedated w/ diprivan and some other sedative still after all this time. CT neg, pupils equal, moves limbs when diprivan off, still combative. nurse described actions were like DTs but pt only drinks 1-2 beers/mo. Any ideas? what could be keeping him from waking up with appropriate responses?

Answer
More likely it is related to two issues; being on the heart lung machine and ICU psychosis. When you are on the heart-lung machine, micro bubbles can go to your brain and, in some cases, can cause these types of reactions. More commonly, ICU psychosis is common in elderly people and it occurs because of the environment of an ICU. The lights are always on, there is noise from the monitors and some degree of sleep deprivation. This situation, also referred to as sundowning, usually goes away within a few days.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston