Expert: Dr Ian Jackson - please note UK based - 3/14/2007

Question
Hello. My grandfather had his bladder taken out due to cancer last Monday and right now he is not doing well at all for several reasons. What I'd like to ask you about is, he has been kept sedated since the morning of surgery over a week ago, and they took him off of all the sedation medicine yesterday. But he still hasn't woken up. And now today they say his eyes are no longer responding to the reflex tests they do. Up until today they had been responding. Do you know if the medication could still be in his system and keeping him still asleep? And also, would it cause the thing with his eyes not responding now? Even though they had been fine up until today? Also his heart rate is really high, between 140-150 and his blood pressure is only in the 80s over 40s. The Drs are now saying his kidney's are functioning correctly and they think he has infection somewhere but the can't figure out where. So I don't know if that has any thing to do with it or not.
Thanks in advance for any help.
-Heather

Answer
Heather
I am sorry to hear about your grandfather, this must be a difficult time for you and your family. Cystectomy is a very large operation and is not without its risks which to a degree increase with the age of the patient.
I assume from your story that your grandfather has been in intensive care since his operation. From the story it is not clear if they have been using drugs to sedate him because he is on a breathing machine (ventilator) or if they have been giving him strong pain killers to keep him comfortable after the operation. To answer your question some of these drugs can take quite a time to wear off once they are stopped. However you then provide me with more information that would suggest another reason for his lack of response - his blood pressure is very low. Even in a young person this can make people less responsive and in the elderly this effect is much increased. The low blood pressure and fast heart rate indicate that he does have a problem which could be due to an infection somewhere. Otherwise one would have to suspect that his heart is not coping with the increased work required of it following the operation. All I can say is that if his kidneys are still working then this is good and I am sure the doctors and nurses in intensive care are working hard to help him recover from this problems.
I hope that things do improve.
Kind regards
Dr Ian Jackson