ABSTRACT
Anaesthetic management is that of any underlying disease found. Both before, and especially after, surgery these patients can pose major ward problems. Frequently, because of their antisocial activities, they tend to be ignored by the ward staff, who request sedation to keep them quiet. Patients cannot grasp what is happening and the environment appears strange and frightening to them. They often misinterpret events around them, and may suffer both delusions and hallucinations that leave them tearful and terrified. This leads to overactivity, objectionable behaviour, and episodes such as attempts to leave the ward or refuse medication. Drips and catheters are pulled out and oxygen masks thrown away. The clouding of consciousness is always worse at night when the visual cues are less clear.
