Postoperative hallucinations are considered among the neurological and psychological complications that may affect some patients, particularly older adults or those with chronic illnesses. This condition usually appears within the first hours or days following surgery and may be temporary or part of a broader disorder known as postoperative delirium. This article aims to explain the concept of postoperative hallucinations, their causes, risk factors, and methods of treatment and prevention. First: Definition of Postoperative Hallucinations Postoperative hallucinations are false sensory perceptions that may be visual, auditory, or tactile, occurring without an actual external stimulus. They are often associated with temporary changes in brain function following anesthesia or surgical intervention. Second: Causes of Hallucinations After Surgery Postoperative hallucinations have multiple possible causes, including: • General anesthesia: Certain anesthetic agents affect neurotransmitters in the brain, which may lead to temporary cognitive and perceptual disturbances. • Postoperative medications: Such as strong analgesics (especially opioids), sedatives, or certain antibiotics. • Postoperative delirium: An acute disturbance of consciousness and attention, commonly observed in elderly patients. • Electrolyte and metabolic imbalances: Including hyponatremia, dehydration, or hypoxia. • Severe pain or sleep deprivation: Both can negatively affect brain function and cognition. • Chronic medical conditions: Such as dementia, diabetes mellitus, renal failure, or liver disease. Third: Types of Postoperative Hallucinations Postoperative hallucinations are classified into several types: • Visual hallucinations: Seeing people or objects that are not present (the most common type). • Auditory hallucinations: Hearing voices or sounds that do not exist. • Tactile hallucinations: Sensations of objects or movement on the skin. • Mixed hallucinations: A combination of more than one type. Fourth: Risk Factors The risk of postoperative hallucinations increases in the following situations: • Advanced age, particularly over 65 years • Major surgical procedures (e.g., cardiac, neurosurgical, or orthopedic surgeries) • Prolonged duration of anesthesia • History of psychiatric or neurological disorders • Prolonged stay in the intensive care unit (ICU) Fifth: Management of Postoperative Hallucinations 1. Medical Management • Reviewing and adjusting medications that may contribute to hallucinations • Treating underlying causes such as hypoxia or electrolyte disturbances • Using low-dose antipsychotic medications when necessary, under close medical supervision 2. Non-Pharmacological Management • Providing a calm, well-lit environment • Reorienting the patient to time and place (reminding them of the date, location, and people around them) • Allowing family members to be present to reassure the patient • Improving sleep quality and minimizing nighttime noise • Encouraging early mobilization after surgery when feasible 3. Psychological Support • Reassuring the patient that the condition is usually temporary • Avoiding confrontation or arguing about the hallucinations • Speaking calmly using short, clear sentences Sixth: Prevention of Postoperative Hallucinations Preventive strategies include: • Preoperative assessment of the patient’s cognitive status • Using the lowest effective dose of anesthetic agents • Adequate pain control • Maintaining proper fluid and electrolyte balance • Avoiding unnecessary sedative medications Conclusion Postoperative hallucinations are a relatively common condition and are often temporary and treatable when identified early and managed appropriately. Both the healthcare team and family members play a crucial role in promoting recovery and preventing complications. A clear understanding of this condition helps reduce anxiety and improve the quality of patient care. Hussein Shadad Al-Mustaqbal University The First University in Iraq