Postoperative Delirium Following Orthognathic Surgery in a Young Patient

Abstract Delirium is an organic mental syndrome with acute onset, characterized by diffuse brain dysfunction and neural activity disorganization. It is usually related to cognition and perception changes, reduced level of consciousness and disorganization of thoughts that are unrelated to previous dementia. Occurrence is found more frequently in patients with previous degenerative disease and elderly patients, especially above 85 years of age. Although the pathophysiology is not totally known, studies have shown that, among the main factors that lead to delirium, drugs used for general anesthesia induction are the most relevant (hypnotics, anticholinergic drugs and H2 receptor blockers), especially those used in long surgical procedures. We present the case of a 24 year-old female patient, with noncontributive medical and psychological history. She underwent bimaxillary orthognathic surgery, with a total general anesthesia time of 7 hours. Postoperatively, she developed agitation, confusion and delirium. After a psychiatry consult and discussion with the anesthesia team, the diagnosis of psychotic break due to late postoperative delirium was established.