Emergence Delirium with Associated Flashback in a Combat Veteran

Recent studies have indicated two phenomena of particular concern for the anesthesia community. That the incidence of PTSD throughout the United States has been on the rise due to our military conflicts abroad and that the incidence of post-operative complications is significantly higher in the patient with known PTSD. These complications have the potential to vary widely, but the most commonly reported issues are centered on Emergence Delirium. The case of a 62-year-old patient with known PTSD provides an educational example of potential complications and how traditional treatment modalities may prove ineffective. Of particular importance is the realization that PTSD patients must receive a focused plan of care for the entire operative experience, instead of a reactive approach once symptoms arise. Typical pharmacologic approaches to Emergence Delirium (e.g. midazolam) are often counterproductive and several sources suggest that the answer lies in an environmental strategy that places a premium on open communication between the anesthesia provider and the patient. Other critical factors include appropriate anesthetic techniques that avoid general anesthesia, and the significance of adequate pain control.