Abstract

Delirium is a common finding after cardiac surgery and can lead to increased morbidity and mortality rates and prolonged intensive care stays. Patients suffering postoperative delirium can experience neurological decline 12 months after surgery regardless of baseline neurological status. Postoperative delirium associated with cardiac surgery is hypothesized to be caused by surgical stress, decreased cardiac output, decreased intracranial perfusion, and prolonged exposure to cardiopulmonary bypass leading to disrupted neuroinflammatory pathways leading to neuronal injury. Dexmedetomidine, an alpha-2 adrenergic agonist, can be neuroprotective and may decrease the incidence of postoperative delirium in cardiac patients.

The case study involved a 69-year-old ASA IV male that presented for coronary bypass grafting surgery. The patient was alert and oriented to person, time, place, and situation and was able to move all extremities well at baseline. He is noted to have a history of alcohol abuse and is a former smoker. He received fentanyl 100 mcg IV, etomidate 15 mg IV, rocuronium 100 mg IV, lidocaine 100 mg IV, and propofol 50 mg IV during induction. The procedure lasted 4 hours 30 minutes including 65 minutes on cardiopulmonary bypass. The patient experienced prolonged mechanical ventilation on postoperative day 0 and displayed altered mental status from postoperative day 0 to postoperative day 2. Nonpharmacological means such as reorientation, frequent family visitation, promoting sleep-wake cycles, ensuring adequate hydration and nutrition, and early mobilization were pursued to no avail. Dexmedetomidine was not administered throughout the patient’s postoperative course. The literature surrounding dexmedetomidine’s potential to minimize postoperative delirium was reviewed in this case study.

Author Details

Lakesha Portis Ivey, DNP(c), BSN, RN - 14 years RN experience Critical Care, Nephrology, Case Management

Lisa Herbinger, DNP, CRNA, FAANA

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Cardiac Surgery, Delirium, Dexmedetomidine, Postoperative Delirium, Postoperative Management

Advisor

Allyson Maddox

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Date of Issue

2026-02-05

Full Text of Presentation

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Abstract.pdf (90 kB)

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