A 74-Year-Old Man Is Evaluated for Acute Agitation Beginning 20

A 74-year-old man is evaluated for acute agitation beginning 20 minutes after arrival to the post-anesthesia care unit (PACU) following abdominal surgery.  He was admitted 5 days ago for a small bowel obstruction and failed nonoperative management.  The patient received lorazepam for preoperative anxiety, and lysis of adhesions was performed under general anesthesia.  His immediate postoperative course was uneventful, and he was responsive and following commands shortly after extubation and on arrival to the PACU.  Medical history is significant for posttraumatic stress disorder.  Temperature is 37.2 C (99 F) , blood pressure is 142/86 mm Hg, pulse is 98/min, and respirations are 18/min.  The patient is anxious, confused, and restless in bed.  He now responds only to questions in Spanish despite being fluent in English minutes before.  His muscles seem tense, but screening neurologic examination reveals no focal abnormalities.  Arterial blood gas shows PaO₂ of 86 mm Hg and PaCO₂ of 38 mm Hg.  Point-of-care electrolytes, glucose, and hematocrit are all normal.  What is the most appropriate initial management of this patient?

A) Administer dantrolene
B) Administer lorazepam
C) Apply soft wrist restraints
D) Obtain CT scan of the head
E) Provide reassurance, reorientation, and observation

Correct Answer:

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