Cognitive impairment in elderly patients in the postoperative period: A clinical case

The study of beta-blocker toxicity in elderly patients with comorbidities is relevant due to the high risk of medication-related complications in the perioperative period. The aim of the study was to investigate the clinical case of a 78-year-old man with hypertension and ischemic heart disease who experienced postoperative complications due to uncontrolled metoprolol intake. The patient underwent elective cataract surgery under propofol sedation, having taken 25 mg of metoprolol daily prior to the procedure. The analysis utilised methods of clinical observation, medication history assessment, and monitoring of physiological parameters. The course of a postoperative complication caused by beta-blocker toxicity was examined, manifesting as bradycardia (45-48 beats/min), hypotension (80/50 mmHg), and reduced consciousness level (Glasgow Coma Scale 11-12 points). Postoperative amnesia in the patient suggested possible delirium, necessitating regular screening. It was determined that unintentional additional metoprolol intake resulted from discrepancies in the medication history. The effectiveness of interventions, including atropine administration, crystalloid infusion, and oxygen therapy, was analysed, which led to partial recovery of consciousness (Glasgow Coma Scale 13-14 points) and an increase in heart rate to 50-54 beats/min. It was concluded that the absence of initial pathological changes during daytime checks highlights the need for continuous monitoring to detect delirium, which frequently occurs in elderly patients. Robust medication reconciliation, including physical inspection of personal belongings and patient education, could prevent such incidents. The study results have practical value for anesthesiologists, surgeons, and clinical pharmacists, who can use these findings to improve medication reconciliation protocols and delirium screening in the perioperative period, enhancing patient safety