Morphine is a Reasonable Alternative to Haloperidol in the Treatment of Postoperative Hyperactive-Type Delirium After Cardiac Surgery

Atalan, Nazan; Sevim, Meltem Efe; Akgün, Serdar; Fazlioğulları, Osman; Başaran, Cem

doi:10.1053/j.jvca.2013.01.017

Cited by 30 publications

(36 citation statements)

References 22 publications

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“…1). Figure 1 describes results of our search strategy [17, 18•, 19–25, 26•]. Of these 10 studies, two focused on the treatment of post-operative delirium with the use of haloperidol, [17] morphine, [17] or ondansetron.…”

Section: Resultsmentioning

confidence: 99%

“…Figure 1 describes results of our search strategy [17, 18•, 19–25, 26•]. Of these 10 studies, two focused on the treatment of post-operative delirium with the use of haloperidol, [17] morphine, [17] or ondansetron. [19] Six studies evaluated the role of haloperidol, [18•] dexmedetomidine, [21] ketamine, [23], risperidone, [24] rivastigmine, [25] and olanzapine [22] to prevent delirium.…”

Section: Resultsmentioning

confidence: 99%

“…The literature search produced two trials that evaluated pharmacologic management approaches to prevention of delirium in the post-operative setting [17, 19]. Both studies compared the use of non-conventional treatments against haloperidol [17, 19], and both studies used haloperidol as the standard of care for a pharmacologic rescue medication when delirium was not controlled.…”

Section: Treatment Of Post-operative Deliriummentioning

confidence: 99%

“…Both studies compared the use of non-conventional treatments against haloperidol [17, 19], and both studies used haloperidol as the standard of care for a pharmacologic rescue medication when delirium was not controlled. The two trials enrolled cardiac surgery patients predominately in the 6th decade of life or older, with majority being males.…”

Section: Treatment Of Post-operative Deliriummentioning

confidence: 99%

“…The trial by Atalan and colleagues [17] compared morphine as an alternative to haloperidol in the treatment of hyperactive delirium. Fifty-three post-cardiac surgery patients diagnosed with hyperactive delirium using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) [27] and Richmond Agitation Sedation Scale [28] were randomized to intramuscular haloperidol versus intramuscular morphine.…”

Section: Treatment Of Post-operative Deliriummentioning

confidence: 99%

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Update on Pharmacotherapy for Prevention and Treatment of Post-operative Delirium: A Systematic Evidence Review

Khan

Gutteridge

Campbell

2015

Curr Anesthesiol Rep

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Delirium is highly prevalent among elderly post-operative patients with no pharmacological intervention approved by the Food and Drug Administration for prevention or treatment. We conducted a systematic evidence review to critically appraise literature related to the pharmacotherapy of post-operative delirium. Ten studies fulfilled our inclusion criteria with two interventions for delirium treatment and eight interventions for delirium prevention in post-operative patients. The quality of evidence of delirium treatment studies was poor, whereas the quality of evidence in delirium prevention studies ranges from moderate to high. Delirium treatment studies find similar delirium duration and length-of-stay outcomes between haloperidol and either morphine or ondansetron. Risperidone was found to reduce the conversion of sub-syndromal delirium to delirium in one study compared to placebo. Haloperidol, olanzapine, and ketamine were each found to reduce delirium incidence, whereas rivastigmine had no impact on delirium incidence or duration. Lighter anesthesia as monitored by bi-spectral index led to a decreased delirium incidence. Considering results from studies conducted prior to the dates of this review, the current evidence suggests that certain pharmacologic classes and lighter sedation using BIS monitoring may prevent post-operative delirium, although a conclusive recommendation for clinical practice must await further research.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Treatment Of Post-operative Deliriummentioning

confidence: 99%

Section: Treatment Of Post-operative Deliriummentioning

confidence: 99%

Section: Treatment Of Post-operative Deliriummentioning

confidence: 99%

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Update on Pharmacotherapy for Prevention and Treatment of Post-operative Delirium: A Systematic Evidence Review

Khan

Gutteridge

Campbell

2015

Curr Anesthesiol Rep

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Delirium in Older Persons

Fong

Hshieh

et al. 2017

JAMA

687

306

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Importance-Delirium is defined as an acute disorder of attention and cognition. It is a common, serious, and often fatal condition among older patients. Although often underrecognized, delirium has serious adverse effects on the individual's function and quality of life, as well as broad societal effect with substantial health care costs.Objective-To summarize the current state of the art in diagnosis and treatment of delirium and to highlight critical areas for future research to advance the field.Evidence Review-We searched Ovid MEDLINE, Embase, and the Cochrane Library for the past 6 years, from January 1, 2011 until March 16, 2017 using a combination of controlled vocabulary and keyword terms. Since delirium is more prevalent in older adults, the focus was on studies in elderly populations; studies based solely in the intensive care unit (ICU) and non-English-language articles were excluded.Findings-Of 127 articles included, 25 were clinical trials, 42 cohort studies, 5 systematic reviews and meta-analyses, and 55 were other categories. A total of 11 616 patients were represented in the treatment studies. Advances in diagnosis have included the development of brief screening tools with high sensitivity and specificity, such as the 3-Minute Diagnostic Assessment, 4 A's test, and proxy-based measures such as the Family Confusion Assessment Method. Measures of severity, such as the Confusion Assessment Method-Severity Score, can aid in monitoring response to treatment, risk stratification, and assessing prognosis. Nonpharmacologic approaches focused on risk factors such as immobility, functional decline, visual or hearing impairment, dehydration, and sleep deprivation are effective for delirium prevention and also are recommended for delirium treatment. Current recommendations for pharmacologic treatment of

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Antipsychotics for treatment of delirium in hospitalised non-ICU patients

Burry

Mehta

Perreault

et al. 2018

Cochrane Database of Systematic Reviews

123

116

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Background Guidelines suggest limited and cautious use of antipsychotics for treatment of delirium where nonpharmacological interventions have failed and symptoms remain distressing or dangerous, or both. It is unclear how well these recommendations are supported by current evidence. Objectives Our primary objective was to assess the efficacy of antipsychotics versus nonantipsychotics or placebo on the duration of delirium in hospitalised adults. Our secondary objectives were to compare the efficacy of: 1) antipsychotics versus nonantipsychotics or placebo on delirium severity and resolution, mortality, hospital length of stay, discharge disposition, health-related quality of life, and adverse effects; and 2) atypical vs. typical antipsychotics for reducing delirium duration, severity, and resolution, hospital mortality and length of stay, discharge disposition, health-related quality of life, and adverse effects. Search methods We searched MEDLINE, Embase, Cochrane EBM Reviews, CINAHL, Thomson Reuters Web of Science and the Latin American and Caribbean Health Sciences Literature (LILACS) from their respective inception dates until July 2017. We also searched the Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database, Web of Science ISI Proceedings, and other grey literature. Selection criteria We included randomised and quasi-randomised trials comparing 1) antipsychotics to nonantipsychotics or placebo and 2) typical to atypical antipsychotics for the treatment of delirium in adult hospitalised (but not critically ill) patients. 1 Antipsychotics for treatment of delirium in hospitalised non-ICU patients (Review)

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Morphine is a Reasonable Alternative to Haloperidol in the Treatment of Postoperative Hyperactive-Type Delirium After Cardiac Surgery

Cited by 30 publications

References 22 publications

Update on Pharmacotherapy for Prevention and Treatment of Post-operative Delirium: A Systematic Evidence Review

Update on Pharmacotherapy for Prevention and Treatment of Post-operative Delirium: A Systematic Evidence Review

Delirium in Older Persons

Antipsychotics for treatment of delirium in hospitalised non-ICU patients

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