Delirium an acutely altered and fluctuating mental status has been a common occurance in the elderly in the post-operative period. Despite this, there have been few studies or cases reported in India. The objective of this case report is to sensitize the medical fraternity towards this condition and its importance.

We report a case of a 70 year old male who developed signs and symptoms suggestive of delirium after a spine surgery. We herebydiscuss the risks, predisposing and precipitating factors, diagnostic methods, preventive measures and treatment strategies of the condition.

With an increase in ageing population, post op delirium no longer remains a concern only for the developed nations and hence necessitates a watchful eye.

Keywords: Post-operative delirium, elderly, India.

1. Robinson TN and Eiseman B. Postoperative delirium in the elderly: diagnosis and management. Clin Interv Aging. 2008 Jun; 3(2): 351–355.
2. Dasgupta M, Dumbrell AC. Preoperative risk assessment for delirium after noncardiac surgery: a systematic review. J Am Geriatr Soc. 2006;54:1578–89.
3. Zeeshan Shaikh, Record 35 per cent jump pushes 60-plus population in India to an all-time high Indian Express April 22nd 2016
4. Jean Mantz, Hugh C. Hemmings,  Jacques Boddaert, Case Scenario: Postoperative Delirium in Elderly Surgical Patients. Anesthesiology 1 2010;112:189-195
5. Bunavendran A, Kroin JS, Berger RA, Hallab NJ, Saha C, Negrescu C, et al, Upregulation of prostaglandin E2 and interleukins in the central nervous system and peripheral tissue during and after surgery in humans. Anesthesiology 2006; 104:403–10
6. Buckner RL: Memory and executive function in aging and AD: Multiple factors that cause decline and reserve factors that compensate. Neuron 2004; 44:195–208
7. Edward R. Marcantonio. Postoperative Delirium A 76­Year­Old Woman With Delirium Following Surgery JAMA. 2012 Jul 4; 308(1): 73–81.
8. Ely EW, Inouye SK,   Bernard GR ,   Gordon S,  Francis J, et al. Delirium in Mechanically Ventilated Patients Validity and Reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) JAMA. 2001;286 (21):2703-10.
9. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189-98.
10. Duckworth GS. The reliability of G.E.M.S. Proceedings of the Ontario Psychogeriatric Association, September 1976:54­9.
11. Pattie AH. A survey version of the Clifton Assessment Procedures for the Elderly (CAPE). Br J Clin Psychol 1981;20:173­8.
12. Trzepacz P, Breitbart W, Franklin J, et al. Practice guideline for the treatment of patients with delirium. American Psychiatric Association. Am J Psychiatry. 1999;156:1–20
13. Lepouse C, Lautner A, Liu L, Gomis P, Leon A. Emergence delirium in adults in the post- anesthesia care unit. Br.J Anaesth 2006;96:747-53.

Prajwala S Kaushik

Assistant Professor, Dept of Anesthesia, GGMC and JJ hospital