32 yrs old female history of 2 LSCS.... LCB 4 yrs back..... Presented with acute appendicitis.... Appendectomy done under SA... Pics attached...... 8 hrs after surgery patient was having tightly closed mouth, responding to commands,,telling her name and residence,,, but couldn't identify the attendants....... Patient was given promethazine.... Which precipitated it further... Patient becum irritable and aggressive..... Controlled with diazepam.... Electrolytes and all investigations normal..... Including NCCT head.... DIAGNOSIS AND MANAGEMENT..



Take past history of bipolar disorder as picture is similar to post partum psychosis which is a definite clinical entity . Acute delirium with hysterical component as females are prone to such episodes. Nothing serious. Once patient is discharged send for psychiatric evaluation.

No similar history.......... Psychiatrist is attending the Patient but no improvement... Patient is on olanzapine

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Acute delirium/ acute confusional state. Reversible. May be related with acute illness/ surgery / drugs/ sleep deprivation.Treat the precipitating facots.Haloperidol/ risperidone drug of choice.

Post operative meningitis most common cause sepsis on spinal anaesthesia.

But day one

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Postoperative delirium Usually responds to benzodizepins Usually short lived and reverts spontaneously Wait and watch, the patient should be fine shortly

@ Counseling Ifollowing appendicectomy Consider exacerbation of drug Anaesthesia Induced psychosis

There are many causes of delirium and confusional states.Dr shivang raj agarwal point of view can also be considered

Not plastic surgery case

Could be after effects of ANAESTHESIA. Or any drug given during or after ANAESTHESIA

But patient was done in spinal anaesthesia

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I agree with Dr Praveen yograj

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