Melatonin and melatonin-receptor agonists to prevent delirium in hospitalized older adults: An umbrella review

Blodgett, Thomas J; Blodgett, Nicole Petsas

doi:10.1016/j.gerinurse.2021.10.011

Cited by 5 publications

(7 citation statements)

References 42 publications

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“…The melatonin dose varied from 0.5 to 5 mg across studies for delirium prevention ( 35 ). A recent expert consensus recommended that the administration of prolonged-release melatonin 2 mg or an immediate-release 3 or 5 mg dose before bedtime may prevent the incidence of delirium in at-risk populations ( 36 ).…”

Section: Discussionmentioning

confidence: 99%

Melatonin and Its Analogs for Prevention of Post-cardiac Surgery Delirium: A Systematic Review and Meta-Analysis

Han

Tian

et al. 2022

Front. Cardiovasc. Med.

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BackgroundThe effectiveness of melatonin and its analogs in preventing postoperative delirium (POD) following cardiac surgery is controversial. The purpose of this systematic review and meta-analysis was to confirm the benefits of melatonin and its analogs on delirium prevention in adults who underwent cardiac surgery.MethodsWe systematically searched the PubMed, Cochrane Library, Web of Science, Embase, and EBSCOhost databases, the last search was performed in October 2021 and repeated before publication. The controlled studies were included if investigated the impact of melatonin and its analogs on POD in adults who underwent cardiac surgery. The primary outcome was the incidence of delirium. The Stata statistical software 17.0 was used to perform this study.ResultsThis meta-analysis included eight randomized controlled trials (RCTs) and two cohort studies with a total of 1,714 patients. The results showed that melatonin and ramelteon administration were associated with a significantly lower incidence of POD in adults who underwent cardiac surgery (odds ratio [OR], 0.46; 95% confidence interval [CI], 0.29–0.74; P = 0.001). The subgroup analyses confirmed that melatonin 3 mg (OR, 0.37; 95% CI, 0.18–0.76; P = 0.007) and 5 mg (OR, 0.34; 95% CI, 0.21–0.56; P < 0.001) significantly reduced the incidence of POD.ConclusionMelatonin at dosages of 5 and 3 mg considerably decreased the risk of delirium in adults who underwent cardiac surgery, according to our results. Cautious interpretation of our results is important owing to the modest number of studies included in this meta-analysis and the heterogeneity among them.Systematic Review RegistrationPROSPERO registration number: CRD42021246984.

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Section: Discussionmentioning

confidence: 99%

Melatonin and Its Analogs for Prevention of Post-cardiac Surgery Delirium: A Systematic Review and Meta-Analysis

Han

Tian

et al. 2022

Front. Cardiovasc. Med.

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“…However, there is no evidence to support this practice except under very specific circumstances (such as routine management of schizophrenia); therefore, scheduled antipsychotics are not appropriate for delirium prevention 29. Since sleep deprivation is a substantial risk factor for delirium, patients with insomnia in the hospital setting may benefit from scheduled melatonin or ramelteon, but more sedating medications (for example, benzodiazepines and zolpidem) should be avoided 30…”

Section: Delirium Preventionmentioning

confidence: 99%

Delirium prevention and management in hospitalized older adults

Blodgett

2023

The Nurse Practitioner

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“…Numerous studies have shown that melatonin can reduce the incidence of delirium in those patients undergoing surgery [ 95 , 96 , 97 ]. Recently, a meta-analysis involving 1712 participants found that melatonin significantly reduced the incidence of delirium, with a risk reduction of 49% in surgical patients [ 96 ].…”

Section: Pathological Theoriesmentioning

confidence: 99%

“…Recently, a meta-analysis involving 1712 participants found that melatonin significantly reduced the incidence of delirium, with a risk reduction of 49% in surgical patients [ 96 ]. In addition to melatonin, ramelteon, an FDA-approved melatonin receptor agonist, has also been shown to prevent delirium [ 97 ].…”

Section: Pathological Theoriesmentioning

confidence: 99%

Postoperative Delirium in Neurosurgical Patients: Recent Insights into the Pathogenesis

Ma²,

Du³

et al. 2022

Brain Sciences

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Postoperative delirium (POD) is a complication characterized by disturbances in attention, awareness, and cognitive function that occur shortly after surgery or emergence from anesthesia. Since it occurs prevalently in neurosurgical patients and poses great threats to the well-being of patients, much emphasis is placed on POD in neurosurgical units. However, there are intricate theories about its pathogenesis and limited pharmacological interventions for POD. In this study, we review the recent insights into its pathogenesis, mainly based on studies within five years, and the five dominant pathological theories that account for the development of POD, with the intention of furthering our understanding and boosting its clinical management.

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Melatonin and melatonin-receptor agonists to prevent delirium in hospitalized older adults: An umbrella review

Cited by 5 publications

References 42 publications

Melatonin and Its Analogs for Prevention of Post-cardiac Surgery Delirium: A Systematic Review and Meta-Analysis

Melatonin and Its Analogs for Prevention of Post-cardiac Surgery Delirium: A Systematic Review and Meta-Analysis

Delirium prevention and management in hospitalized older adults

Postoperative Delirium in Neurosurgical Patients: Recent Insights into the Pathogenesis

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