Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review

Qingqing Huang; Xuemei Dai; Shuai Xu; Libang Yuan; Gu Gong

doi:doi:10.11648/j.ajpn.20221003.11

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Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review

Qingqing Huang, Xuemei Dai, Shuai Xu, Libang Yuan, Gu Gong

Published in American Journal of Psychiatry and Neuroscience (Volume 10, Issue 3)

Received: 16 June 2022 Accepted: 29 June 2022 Published: 20 July 2022

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Abstract

Background: Currently, postoperative delirium is a common postoperative complication in elderly patients. However, it lacks effective treatment measures, and this case report strives to find a more effective treatment method based on the existing treatment measures. Objectives: The aim of this study was to investigate the efficacy of intranasal insulin combined with low-dose propofol in the treatment of refractory delirium. Methods: Five days after a 66-year-old woman underwent surgery under general anesthesia, she underwent surgery again under general anesthesia. After the second operation, the patient was sent to the ICU to continue observation. On the second day after entering the ICU, the patient was confused, restless, increased speech, unable to respond correctly, and had aggressive behavior. After the neurologist's treatment was invalid, the anesthesiologist was invited again for consultation. The anesthesiologist evaluated the patient through the RASS scale, CAM-ICU scale and CAM-R scale and found that the patient was currently in a state of delirium. Therefore, it was decided to take TCI target-controlled infusion of propofol, intranasal insulin administration, and dynamic monitoring of the patient's breathing with a microfluidic end-tidal carbon dioxide (PETCO2) monitor through a nasal cannula to control the patient's delirium state. Results: After 36 hours of treatment, the patient was conscious and quiet, communicated to the point, and had a clear understanding of the surrounding environment. Conclusion: Intranasal insulin combined with low-dose propofol can provide reference for the treatment of intractable delirium.

Published in	American Journal of Psychiatry and Neuroscience (Volume 10, Issue 3)
DOI	10.11648/j.ajpn.20221003.11
Page(s)	86-88
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Intranasal Insulin, Propofol, The Microstream PETCO2 Monitor Via the Nasal Catheter, Postoperative Delirium

References

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[2]	Leslie D L, Inouye S K. The importance of delirium: economic and societal costs. J Am Geriatr Soc. 2011; 59 Suppl 2: S241-S243.
[3]	Ali S, Patel M, Jabeen S, et al. Insight into delirium. Innov Clin Neurosci. 2011; 8 (10): 25-34.
[4]	Pavlović DB, Tonković D, Bogović TZ, et al. Prevencija i terapija bolesnika s delirijem u jedinici intenzivnog lijecenja [Prevention and treatment of intensive care unit delirium]. Acta Med Croatica. 2012; 66 (1): 49-53.
[5]	Folino TB, Muco E, Safadi AO, et al. Propofol. 2021 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2021.
[6]	McCowan C, Marik P. Refractory delirium tremens treated with propofol: a case series. Crit Care Med. 2000; 28 (6): 1781-4.
[7]	Beirami E, Oryan S, Seyedhosseini Tamijani SM, et al. Intranasal insulin treatment alleviates methamphetamine induced anxiety-like behavior and neuroinflammation. Neurosci Lett. 2017; 660: 122-129.
[8]	Huang Q, Li Q, Qin F, et al. Repeated Preoperative Intranasal Administration of Insulin Decreases the Incidence of Postoperative Delirium in Elderly Patients Undergoing Laparoscopic Radical Gastrointestinal Surgery: A Randomized, Placebo-Controlled, Double-Blinded Clinical Study. Am J Geriatr Psychiatry. 2021; 23: S1064-7481 (21) 00216-5.
[9]	Lochan R, Joypaul BV. Bile peritonitis due to intra-hepatic bile duct rupture. World J Gastroenterol. 2005; 11 (42): 6728-9.
[10]	JR Maldonado. Neuropathogenesis of delirium: review of current etiologic theories and common pathways. Am J Geriatr Psychiatry. 2013; 21: 1190-1222.
[11]	B Riedel, K Browne, B Silbert. Cerebral protection: inflammation, endothelial dysfunction, and postoperative cognitive dysfunction. Curr Opin Anaesthesiol. 2014; 27: 89-97.
[12]	S Vacas, V Degos, X Feng, et al. The neuroinflammatory response of postoperative cognitive decline. Br Med Bull. 2013; 106: 161-178.
[13]	Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol. 2017; 34 (4): 192-214.
[14]	Lorentzen K, Lauritsen AØ, Bendtsen AO. Use of propofol infusion in alcohol withdrawal-induced refractory delirium tremens. Dan Med J. 2014; 61 (5): A4807.
[15]	Coomes TR, Smith SW. Successful use of propofol in refractory delirium tremens. Ann Emerg Med. 1997; 30 (6): 825-8.
[16]	Beirami E, Oryan S, Seyedhosseini T S, et al. Intranasal insulin treatment alleviates methamphetamine induced anxiety-like behavior and neuroinflammation. Neurosci Lett. 2017; 660: 122-129.
[17]	Mamik M K, Asahchop E L, Chan W F, et al. Insulin Treatment Prevents Neuroinflammation and Neuronal Injury with Restored Neurobehavioral Function in Models of HIV/AIDS Neurodegeneration. J Neurosci. 2016; 36 (41): 10683-10695.

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APA Style

Qingqing Huang, Xuemei Dai, Shuai Xu, Libang Yuan, Gu Gong. (2022). Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review. American Journal of Psychiatry and Neuroscience, 10(3), 86-88. https://doi.org/10.11648/j.ajpn.20221003.11

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ACS Style

Qingqing Huang; Xuemei Dai; Shuai Xu; Libang Yuan; Gu Gong. Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review. Am. J. Psychiatry Neurosci. 2022, 10(3), 86-88. doi: 10.11648/j.ajpn.20221003.11

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AMA Style

Qingqing Huang, Xuemei Dai, Shuai Xu, Libang Yuan, Gu Gong. Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review. Am J Psychiatry Neurosci. 2022;10(3):86-88. doi: 10.11648/j.ajpn.20221003.11

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@article{10.11648/j.ajpn.20221003.11,
  author = {Qingqing Huang and Xuemei Dai and Shuai Xu and Libang Yuan and Gu Gong},
  title = {Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review},
  journal = {American Journal of Psychiatry and Neuroscience},
  volume = {10},
  number = {3},
  pages = {86-88},
  doi = {10.11648/j.ajpn.20221003.11},
  url = {https://doi.org/10.11648/j.ajpn.20221003.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20221003.11},
  abstract = {Background: Currently, postoperative delirium is a common postoperative complication in elderly patients. However, it lacks effective treatment measures, and this case report strives to find a more effective treatment method based on the existing treatment measures. Objectives: The aim of this study was to investigate the efficacy of intranasal insulin combined with low-dose propofol in the treatment of refractory delirium. Methods: Five days after a 66-year-old woman underwent surgery under general anesthesia, she underwent surgery again under general anesthesia. After the second operation, the patient was sent to the ICU to continue observation. On the second day after entering the ICU, the patient was confused, restless, increased speech, unable to respond correctly, and had aggressive behavior. After the neurologist's treatment was invalid, the anesthesiologist was invited again for consultation. The anesthesiologist evaluated the patient through the RASS scale, CAM-ICU scale and CAM-R scale and found that the patient was currently in a state of delirium. Therefore, it was decided to take TCI target-controlled infusion of propofol, intranasal insulin administration, and dynamic monitoring of the patient's breathing with a microfluidic end-tidal carbon dioxide (PETCO2) monitor through a nasal cannula to control the patient's delirium state. Results: After 36 hours of treatment, the patient was conscious and quiet, communicated to the point, and had a clear understanding of the surrounding environment. Conclusion: Intranasal insulin combined with low-dose propofol can provide reference for the treatment of intractable delirium.},
 year = {2022}
}

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TY  - JOUR
T1  - Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review
AU  - Qingqing Huang
AU  - Xuemei Dai
AU  - Shuai Xu
AU  - Libang Yuan
AU  - Gu Gong
Y1  - 2022/07/20
PY  - 2022
N1  - https://doi.org/10.11648/j.ajpn.20221003.11
DO  - 10.11648/j.ajpn.20221003.11
T2  - American Journal of Psychiatry and Neuroscience
JF  - American Journal of Psychiatry and Neuroscience
JO  - American Journal of Psychiatry and Neuroscience
SP  - 86
EP  - 88
PB  - Science Publishing Group
SN  - 2330-426X
UR  - https://doi.org/10.11648/j.ajpn.20221003.11
AB  - Background: Currently, postoperative delirium is a common postoperative complication in elderly patients. However, it lacks effective treatment measures, and this case report strives to find a more effective treatment method based on the existing treatment measures. Objectives: The aim of this study was to investigate the efficacy of intranasal insulin combined with low-dose propofol in the treatment of refractory delirium. Methods: Five days after a 66-year-old woman underwent surgery under general anesthesia, she underwent surgery again under general anesthesia. After the second operation, the patient was sent to the ICU to continue observation. On the second day after entering the ICU, the patient was confused, restless, increased speech, unable to respond correctly, and had aggressive behavior. After the neurologist's treatment was invalid, the anesthesiologist was invited again for consultation. The anesthesiologist evaluated the patient through the RASS scale, CAM-ICU scale and CAM-R scale and found that the patient was currently in a state of delirium. Therefore, it was decided to take TCI target-controlled infusion of propofol, intranasal insulin administration, and dynamic monitoring of the patient's breathing with a microfluidic end-tidal carbon dioxide (PETCO2) monitor through a nasal cannula to control the patient's delirium state. Results: After 36 hours of treatment, the patient was conscious and quiet, communicated to the point, and had a clear understanding of the surrounding environment. Conclusion: Intranasal insulin combined with low-dose propofol can provide reference for the treatment of intractable delirium.
VL  - 10
IS  - 3
ER  -

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Author Information

Qingqing Huang

Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, PR China
Xuemei Dai

Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, PR China
Shuai Xu

Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, PR China
Libang Yuan

Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, PR China
Gu Gong

Department of Anesthesiology, The General Hospital of Western Theater Command, Chengdu, PR China

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APA Style

Qingqing Huang, Xuemei Dai, Shuai Xu, Libang Yuan, Gu Gong. (2022). Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review. American Journal of Psychiatry and Neuroscience, 10(3), 86-88. https://doi.org/10.11648/j.ajpn.20221003.11

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ACS Style

Qingqing Huang; Xuemei Dai; Shuai Xu; Libang Yuan; Gu Gong. Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review. Am. J. Psychiatry Neurosci. 2022, 10(3), 86-88. doi: 10.11648/j.ajpn.20221003.11

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AMA Style

Qingqing Huang, Xuemei Dai, Shuai Xu, Libang Yuan, Gu Gong. Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review. Am J Psychiatry Neurosci. 2022;10(3):86-88. doi: 10.11648/j.ajpn.20221003.11

Copy | Download

@article{10.11648/j.ajpn.20221003.11,
  author = {Qingqing Huang and Xuemei Dai and Shuai Xu and Libang Yuan and Gu Gong},
  title = {Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review},
  journal = {American Journal of Psychiatry and Neuroscience},
  volume = {10},
  number = {3},
  pages = {86-88},
  doi = {10.11648/j.ajpn.20221003.11},
  url = {https://doi.org/10.11648/j.ajpn.20221003.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20221003.11},
  abstract = {Background: Currently, postoperative delirium is a common postoperative complication in elderly patients. However, it lacks effective treatment measures, and this case report strives to find a more effective treatment method based on the existing treatment measures. Objectives: The aim of this study was to investigate the efficacy of intranasal insulin combined with low-dose propofol in the treatment of refractory delirium. Methods: Five days after a 66-year-old woman underwent surgery under general anesthesia, she underwent surgery again under general anesthesia. After the second operation, the patient was sent to the ICU to continue observation. On the second day after entering the ICU, the patient was confused, restless, increased speech, unable to respond correctly, and had aggressive behavior. After the neurologist's treatment was invalid, the anesthesiologist was invited again for consultation. The anesthesiologist evaluated the patient through the RASS scale, CAM-ICU scale and CAM-R scale and found that the patient was currently in a state of delirium. Therefore, it was decided to take TCI target-controlled infusion of propofol, intranasal insulin administration, and dynamic monitoring of the patient's breathing with a microfluidic end-tidal carbon dioxide (PETCO2) monitor through a nasal cannula to control the patient's delirium state. Results: After 36 hours of treatment, the patient was conscious and quiet, communicated to the point, and had a clear understanding of the surrounding environment. Conclusion: Intranasal insulin combined with low-dose propofol can provide reference for the treatment of intractable delirium.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Intranasal Insulin Combined with Low-Dose Propofol in the Treatment of Postoperative Intractable Delirium: A Case Report and Literature Review
AU  - Qingqing Huang
AU  - Xuemei Dai
AU  - Shuai Xu
AU  - Libang Yuan
AU  - Gu Gong
Y1  - 2022/07/20
PY  - 2022
N1  - https://doi.org/10.11648/j.ajpn.20221003.11
DO  - 10.11648/j.ajpn.20221003.11
T2  - American Journal of Psychiatry and Neuroscience
JF  - American Journal of Psychiatry and Neuroscience
JO  - American Journal of Psychiatry and Neuroscience
SP  - 86
EP  - 88
PB  - Science Publishing Group
SN  - 2330-426X
UR  - https://doi.org/10.11648/j.ajpn.20221003.11
AB  - Background: Currently, postoperative delirium is a common postoperative complication in elderly patients. However, it lacks effective treatment measures, and this case report strives to find a more effective treatment method based on the existing treatment measures. Objectives: The aim of this study was to investigate the efficacy of intranasal insulin combined with low-dose propofol in the treatment of refractory delirium. Methods: Five days after a 66-year-old woman underwent surgery under general anesthesia, she underwent surgery again under general anesthesia. After the second operation, the patient was sent to the ICU to continue observation. On the second day after entering the ICU, the patient was confused, restless, increased speech, unable to respond correctly, and had aggressive behavior. After the neurologist's treatment was invalid, the anesthesiologist was invited again for consultation. The anesthesiologist evaluated the patient through the RASS scale, CAM-ICU scale and CAM-R scale and found that the patient was currently in a state of delirium. Therefore, it was decided to take TCI target-controlled infusion of propofol, intranasal insulin administration, and dynamic monitoring of the patient's breathing with a microfluidic end-tidal carbon dioxide (PETCO2) monitor through a nasal cannula to control the patient's delirium state. Results: After 36 hours of treatment, the patient was conscious and quiet, communicated to the point, and had a clear understanding of the surrounding environment. Conclusion: Intranasal insulin combined with low-dose propofol can provide reference for the treatment of intractable delirium.
VL  - 10
IS  - 3
ER  -

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