Objective:

To explore the use of intranasal dexmedetomidine as a rescue therapy for established postoperative delirium (POD) in a patient who self-removed his IV access.

Approach:

• Patient Description: A 70-year-old man with a history of cerebral infarction developed POD after urologic surgery. He exhibited agitation and self-removed his IV catheter.
• Intervention: Intranasal dexmedetomidine was administered in a stepwise titration protocol totaling 100 μg after IV diazepam failed to provide relief.

Key Findings:

• The patient transitioned from agitation to calm and entered sustained sleep within 1 hour after IN dexmedetomidine administration.
• Mild bradycardia was observed, but no clinically significant respiratory depression occurred.
• The CAM test result was negative on postoperative day 2, and the patient was discharged on postoperative day 4.

Interpretation:

IN dexmedetomidine may provide a safe, non-invasive option for managing established POD when IV access is unavailable.

Limitations:

• The study is based on a single case report, limiting generalizability.
• No formal baseline cognitive assessment was conducted preoperatively.

Conclusion:

IN dexmedetomidine may be an effective alternative for managing POD in patients without IV access.