PBHI Article

Creative Approaches to Soothing Patients at Risk for Delirium

For other anesthesiologists interested in the “less is more approach”, Dr. Cornett suggests keeping delirium on your radar during your preop discussion with older surgical patients and adjusting your surgical protocol accordingly.

May 10, 2018
by Sandra Gordon for ASA

After Jacob Cornett, M.D., an anesthesiologist with Newport Harbor Anesthesia Consultants, which services hospitals in Newport Harbor and Irvine, California, including Hoag Memorial Hospital Presbyterian in Newport Beach, assesses older surgical patients at risk for delirium, he may decide to supplement his anesthetic with non-pharmacological relaxation techniques.

Such was the case with a patient in her 80s about to undergo a hip hemiarthroplasty. During a preoperative discussion with the patient and her family, Dr. Cornett was told: “Every time Mom goes into the hospital, she comes out combative and screaming.” After administering a spinal anesthetic, with only a single small dose of propofol to aid in positioning, Dr. Cornett kept the patient comfortable with minimal use of anesthetic by:

  • Playing music the patient enjoys. After asking the patient about her music preferences, Dr. Cornett played Big Band Era music in the operating room.
  • Reducing ambient noise. To further reduce distracting and disconcerting surgical noises, such as the buzz of power tools and to create a cocoon-like effect, Dr. Cornett placed a warm blanket around the patient’s head. “Patients may not hear the music as well, but it helps keep the overall loudness of the room to a minimum,” Dr. Cornett says.
  • Preparing the patient for the sounds of the operating room. Music and muffling are great ways to distract, but they don’t drown out everything, such as the high-pitched whirr of a surgical saw, Dr. Cornett cautions. That’s why preparing the patient for what to expect, such as “You’re going to hear the sound of a saw,” is also a part of his protocol.
  • Prepping the surgical team. Dr. Cornett also talked with the surgical team, cautioning them to keep the conversation in the O.R. positive. “I make sure everybody in the room knows we have an awake patient,” Dr. Cornett says.
  • Interacting with the patient. Dr. Cornett also talked with the patient throughout the case. “Sometimes I have a conversation about their life and interests. It’s more work than just sitting there,” he says. “But it’s part of the whole experience. I enjoy hearing about people’s life stories. It’s a win for both of us.”

Dr. Cornett has been practicing for 15 years and has been interested in non-pharmacological adjuncts to anesthesia. “I’ve always had an awareness that less is more,” he says. “But over the last three to five years, it’s becoming more in the general conscious and it’s heightened my interest in it. It matches with my general feeling about the whole process.”

For other anesthesiologists interested in the “less is more approach”, Dr. Cornett suggests keeping delirium on your radar during your preop discussion with older surgical patients and adjusting your surgical protocol accordingly. “If you come up with an alternative plan that matches what the patient needs, you can often get the patient’s buy in,” he says.

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