Antipsychotic Drugs in Prevention of Postoperative Delirium—What Is Known in 2020?

Pluta, Michał; Dziech, Magdalena; Czempik, Piotr F.; Szczepańska, Anna; Krzych, Łukasz J.

doi:10.3390/ijerph17176069

Cited by 13 publications

(11 citation statements)

References 60 publications

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“…Pharmacologic strategies for the prevention and management of POD in geriatric patients with hip fractures have been studied for many years, while effective candidate drugs with strong evidence have not been found yet ( Pluta et al, 2020 ). Drugs such as steroids ( Swarbrick and Partridge, 2022 ), melatonin ( Campbell et al, 2019 ), and vitamin D ( Hung et al, 2022 ) have all been reported to be associated with POD, but all lack strong evidence.…”

Section: Prevention and Treatmentmentioning

confidence: 99%

“…FGAs are also known as typical antipsychotics and relate to increased risks of psychomotor complications; SGAs are also called atypical antipsychotics and are linked to higher chances of cardiovascular and metabolic complications ( Jin et al, 2020 ). The effect of antipsychotics on POD in geriatric patients with hip fractures is still doubtful, owing to minimal evidence and variable complications of them ( Pluta et al, 2020 ).…”

Section: Prevention and Treatmentmentioning

confidence: 99%

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Postoperative delirium in geriatric patients with hip fractures

Chen

Liang

et al. 2022

Front. Aging Neurosci.

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Postoperative delirium (POD) is a frequent complication in geriatric patients with hip fractures, which is linked to poorer functional recovery, longer hospital stays, and higher short-and long-term mortality. Patients with increased age, preoperative cognitive impairment, comorbidities, perioperative polypharmacy, and delayed surgery are more prone to develop POD after hip fracture surgery. In this narrative review, we outlined the latest findings on postoperative delirium in geriatric patients with hip fractures, focusing on its pathophysiology, diagnosis, prevention, and treatment. Perioperative risk prediction, avoidance of certain medications, and orthogeriatric comprehensive care are all examples of effective interventions. Choices of anesthesia technique may not be associated with a significant difference in the incidence of postoperative delirium in geriatric patients with hip fractures. There are few pharmaceutical measures available for POD treatment. Dexmedetomidine and multimodal analgesia may be effective for managing postoperative delirium, and adverse complications should be considered when using antipsychotics. In conclusion, perioperative risk intervention based on orthogeriatric comprehensive care is the most effective strategy for preventing postoperative delirium in geriatric patients with hip fractures.

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Section: Prevention and Treatmentmentioning

confidence: 99%

Section: Prevention and Treatmentmentioning

confidence: 99%

Postoperative delirium in geriatric patients with hip fractures

Chen

Liang

et al. 2022

Front. Aging Neurosci.

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“…[26][27][28] Evidence for the use of antipsychotic drugs in prophylaxis of delirium is insufficient, and most studies have shown no benefit of antipsychotics in reducing the duration or severity of delirium. 29,30 And some adverse effects such as extrapyramidal symptoms and increasing the corrected QT interval need to be noticed. 26 Current evidence does not support the use of antipsychotics to treat or prevent delirium in hospitalized older adults.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Remimazolam Besylate versus Dexmedetomidine for Sedation in Non-Intubated Older Patients with Agitated Delirium After Orthopedic Surgery: A Randomized Controlled Trial

Deng¹,

Qin²,

Wu³

et al. 2022

DDDT

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The purpose of the present study was to investigate the efficacy and safety of remimazolam besylate compared with dexmedetomidine for the relief of agitated delirium in non-intubated older patients after orthopedic surgery. Patients and methods: Seventy-five patients were randomly divided into two groups. Patients assigned to the remimazolam group received a loading dose of 0.075 mg/kg remimazolam besylate over 1 minute, followed by a continuous infusion of 0.1 to 0.3 mg/kg/h. Subjects randomized to the dexmedetomidine group received a loading infusion of 0.5 μg/kg dexmedetomidine over 10 minutes, followed by a maintenance dose of 0.2 to 0.7 μg/kg/h. Meanwhile, RASS score-guided dose titration was followed. To assess the efficacy of the study drugs in terms of time to resolution of agitation, time to first achievement of target sedation, percentage of time within the target sedation range, and time to delirium resolution. Safety of the sedatives was evaluated by adverse events during hospitalization. Results: Time to resolution of agitation did not differ between the two groups. The time to first achievement of target sedation was 19.0 (9.5 to 31.0) minutes for remimazolam besylate vs 43.5 (15.0 to 142.5) minutes for dexmedetomidine (P < 0.001). Percentage of time within the target sedation range was 77.8% for remimazolam besylate-treated patients and 67.4% for dexmedetomidine-treated patients (P = 0.001). Patients in the remimazolam group had longer time to delirium resolution (29.5 [21.3 to 32.5] hours) than those in the dexmedetomidine group (22.8 [18.9 to 28.5] hours) (P = 0.042). Patients sedated with remimazolam besylate had more oversedation (P = 0.036) but less hypotension (P = 0.007). Conclusion: Compared with dexmedetomidine, remimazolam besylate was equally effective in relieving agitation, and resulted in earlier achievement of sedation goal and more controllable sedation. Remimazolam may be an ideal agent for obtaining rapid tranquillisation.

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“…It has been reported that some drugs with neuroprotective effects are closely related to the anti-inflammatory properties. 35 , 36 However, the preventive role of these drugs for POD is still unclear, 37 which may be attributed to the complex pathogenesis of POD and the undefined key regulatory molecules during POD development.…”

Section: Discussionmentioning

confidence: 99%

The Potential Protective Effect of Mesencephalic Astrocyte-Derived Neurotrophic Factor on Post-Operative Delirium via Inhibiting Inflammation and Microglia Activation

Liu¹,

Shen²,

Zhang³

et al. 2021

JIR

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Background The increased inflammation is closely correlated with post-operative delirium (POD). Mesencephalic astrocyte-derived neurotrophic factor (MANF) shows protective effect on inflammatory diseases. However, the relationship between MANF and POD is still undefined. This study aimed to explore the potential effect of MANF on POD. Methods Pre- and post-operative levels of MANF and inflammatory cytokines were measured in serum from POD and non-POD patients by ELISA, as well as endogenous MANF in serum from healthy individuals with different ages. Endogenous MANF in mice brain from different ages was also measured. Abdominal surgery was performed for POD mice model. POD-like behavior changes in mice were evaluated using buried food test, open field test and Y maze test. Results Endogenous MANF was decreased in age-dependent manner in both humans and mice. The pre-operative level of MANF in serum from POD patients was lower compared with that in non-POD patients (p=0.016). MANF increase in serum after surgery was less in POD patients than that in non-POD patients (p<0.001). In mice, recombinant human MANF reversed the surgery-induced elongation of latency to eat food, increase in latency to center and increase in time in center in open field test, and also increase in duration in novel arm in Y maze test. In addition, MANF inhibited surgery-induced inflammation, microglial activation and M1 polarization in mice. Conclusion The relative low MANF level may contribute to POD in the elderly. MANF has a protective role against POD-like behavior changes in mice.

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Antipsychotic Drugs in Prevention of Postoperative Delirium—What Is Known in 2020?

Cited by 13 publications

References 60 publications

Postoperative delirium in geriatric patients with hip fractures

Postoperative delirium in geriatric patients with hip fractures

Efficacy and Safety of Remimazolam Besylate versus Dexmedetomidine for Sedation in Non-Intubated Older Patients with Agitated Delirium After Orthopedic Surgery: A Randomized Controlled Trial

The Potential Protective Effect of Mesencephalic Astrocyte-Derived Neurotrophic Factor on Post-Operative Delirium via Inhibiting Inflammation and Microglia Activation

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