How do anesthesiologists get people to sleep?

Sleep, Pain & Delirium

Information for relatives

Many patients who have to be treated in a wake-up or intensive care unit are drowsy or unconscious from the consequences of their illness or from the medication. However, from observations and conversations with patients, we know that hearing, the feeling of the skin and smelling are primarily intact. For this reason, the establishment of contact focuses on these areas of perception. So talk to your loved one and touch them calmly, even if they don't seem to be responding to it. If you are unsure about the catheter and tubing, please ask us.

If you perceive your loved one as a different person, for example restless or apathetic, absent or hallucinating, anxious or aggressive, sleepless or in a twilight state, overzealous or very slowed down, negative or unusually close - and this is in constant change, then speak we of a postoperative delirium or state of confusion.

Postoperative delirium is usually a temporary state of confusion that can occur after an operation. More than a third of all patients treated in a wake or intensive care unit after major surgery are affected. But also patients after a stroke or patients in a medical intensive care unit are affected with similar frequency. These unfamiliar behaviors are due to chemical processes in the brain. The cause is not yet fully understood. It is believed that there is an imbalance of messenger substances in the brain that disrupts the transmission of information. This condition is probably triggered by an inflammatory or inflammation-like process, which can be an expression of the disease itself or a result of the intervention.

The acute phase can last from a few hours to many days. Symptoms are usually observed within the first two days. The course can be very different. Phases of complete orientation often alternate with phases in which the patient is unrecognizable. Especially in older people, the so-called hypoactive delirium is often in the foreground.

There are drugs that can help restore the original balance of messenger substances. Almost more important are accompanying measures to reduce external stimuli, the aim being to reorient the patient. You can support us in this. Face your loved one calmly, speak to them clearly. Provide orientation aids in the form of an easy-to-read clock on the desk and a calendar. Bring personal belongings. Do not take insults or nonsensical statements personally, talk to us about your observations. After the symptoms have subsided, some patients may remember the delirium. They often find it difficult to classify these things or they feel ashamed and uncomfortable talking about them. We have specially trained psychologists who can give you and your loved ones professional assistance.

Postoperative delirium is a relatively newly recognized clinical picture. The Heidelberg University Hospital has developed a concept that primarily focuses on preventive measures and targeted therapeutic steps. In our intensive care units, a special score is also collected three times a day, which allows us to recognize potential delirium at an early stage.

It is important that post-operative pain is managed. Apart from the personal well-being of our patients, which remains our priority, pain is a burden and limitation for the body. In the absence of or inadequate pain therapy, the risk of complications can be increased. Good pain therapy is guaranteed at all times through individual standards, optimally trained staff and the acute pain service.