Expert: JM Starkman, MD - 8/24/2010

Question
Hi there,
My grandfather (79 year old diabetic with COPD) went in to have a valve
replaced on Tuesday morning around 6am. They apparently kept him sedated
in the ICU afterward until aprox 6:30am Wednesday morning. It is now
5:45pm on the following Monday, and he has yet to wake up. He bites on his
ventilator tube (he actually broke 2 teeth and had to have a bite block put in),
moves his legs, head, and arms (not when asked), but has yet to open his eyes
or make noise. He's has a permanent pacemaker put in while in the hospital
(local not general was used for this), his vitals all look great, he's being given
60% oxygen, and his temp has been consistent and regular.

This morning, a CT and an EEG were both performed, which showed no
evidence of trauma.

Is there something else we should be asking the doctors to do? We're on day
6, with no sign of him waking up yet.

Is this common? Is it permanent?

Answer
"Cognitive Impairment" or "cognitive dysfunction" are the terms used for neurological disturbances long after anesthetic medications have been metabolized or otherwise gone from one's body.  Open heart procedures carry the highest risk of such, but the incidence has been reduced with the use of intraoperative echocardiograms and less invasive means of fixing various heart ailments.  If you Google the above terms with "anesthesia" and "open heart" you'll get a plethora of info on the matter. In the meantime, here's the answer to your question:  Is there something else we should be asking the doctors to do?

Yes.  Discontinue all medications. Exceptions would be insulin or a diabetic medication to control his blood sugar, bronchodilators IF HE NEEDS IT to stabilize his breathing and BP medication that has no central acting component (ie no clonidine).  Make sure your Dad is WELL-hydrated (he should be making alot of urine--if not he needs alot of fluid in his intravenous line--if they've already started talking about his kidneys not doing well he REALLY needs alot of fluid in his intravenous line.)  And make sure they are moving to get him off the ventilator.




Best wishes and good luck to your grandfather!