Passage syndrome after bypass surgery

Bypass surgery is an attempt to improve the blood flow situation in the heart by bridging constrictions in the coronary arteries with the body’s own blood vessels. This is usually a routine procedure. However, the patient is normally connected to a heart–lung machine during the operation.

This machine can temporarily take over the function of the heart and lungs. After this type of surgery, however, patients have a significantly increased risk of developing a so-called passage syndrome postoperatively. Patients appear restless, sometimes disoriented and uncooperative, e.g. by independently removing catheters or infusion needles.

Consciousness is usually slightly clouded, similar to a half-sleep state, but paranoid states and delusions can also occur. This may be accompanied by sweating, an increase in blood pressure (see hypertension) and tachycardia (see cardiac arrhythmia) as signs of activation of the autonomic nervous system (see nervous system). The symptoms begin suddenly, in connection with surgical procedures often with a delay of several days after the procedure, and continue with varying severity for hours or days. Those affected often cannot remember the episodes themselves afterwards.

Diagnostics

Causes of acute organic psychosyndromes in inpatients include drugs (side effects), metabolic and mineral disorders, infections, but also psychological reactions to the perceived threat of the disease. Due to their frequency and dangerousness, it is particularly important to clarify e.g. hypoglycaemia of the patient (blood sugar control; see diabetes mellitus), oxygen deficiency (blood gas analysis) and systemic infections (“sepsis”; control of inflammation values in the blood sample and fever measurements).

Treatment

After the passage syndrome has been clearly diagnosed, a special treatment is required that focuses on stabilizing the patient’s psychological condition. The extent to which treatment is necessary depends largely on the severity and severity of the passage syndrome. In some patients, the confusion does not last long and good care is sufficient to help the patient get back into a state of mental health.

Nevertheless, a therapy with appropriate medication is usually recommended by the doctors, as it can prevent the condition from worsening. The focus is that the patient is able to orientate himself again and to a large extent can care for himself and take care of himself as long as no other more serious illness is present. Medically, patients with a passing syndrome are treated with neuroleptics.

This is a drug from the group of psychotropic drugs. They are used to treat diseases that impair thinking and especially perception.Neuroleptics have a calming effect on sensory perception by inhibiting the transmission of excitation by the neurotransmitter dopamine in the brain at the synapses. In the case of a through syndrome, they are often injected via the vein, so they have a rapid effect in acute sutuation and relieve the symptoms.

The drugs haloperidol or risperidone are often used in the clinic. They have a calming effect and also improve the patient’s sleep, so that he or she can rest more easily and his or her symptoms improve fundamentally. If the patient also suffers from a depressive disorder, the neuroleptics can also be supplemented with psychotropic drugs.

Antidepressants or benzodiazepines are then also administered. The latter is also a sedative and sleeping aid, which also develops its effect by inhibiting the neurotransmitters at the synapses in the brain. Furthermore, the symptoms triggered by the patient’s situation are treated.

Thus, appropriate medication is given to treat high blood pressure and pulse. If the patient is discharged despite a continuity syndrome because he can be sufficiently cared for at home by relatives, alcoholic beverages should continue to be avoided. Due to the effect that alcohol has on the brain, the symptoms can worsen again.

In most cases, however, passage syndrome is preceded by a serious operation, so that the patient is often monitored and cared for in hospital for even longer. In the initial phase, intensive medical care is often necessary. For relatives, the patient’s condition is often not understandable and is a great burden. They must also be supported and instructed on how best to help and support the patient. For many, dealing with a person who is not quite himself is a challenge.