Rivastigmine in the treatment of postoperative delirium: a pilot clinical trial

Zaslavsky, Alexander; Haile, Michael; Kline, Rick; Iospa, Alla; Frempong-Boadu, Anthony; Bekker, Alex

doi:10.1002/gps.2801

Cited by 16 publications

(17 citation statements)

References 6 publications

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“…Four placebo-controlled delirium prevention trials with donepezil (two studies) and rivastigmine (two studies) failed to show efficacy of either of those medications in reducing delirium incidence or severity. (62, 63, 68, 70)…”

Section: Prevention Of Delirium: Pharmacological Interventionsmentioning

confidence: 99%

Prevention of post-operative delirium in older patients with cancer undergoing surgery

Korc‐Grodzicki

Root

Alici

2015

Journal of Geriatric Oncology

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Post-operative delirium (POD) occurs in as much as 50% of all surgical cancer patients, with older patients being particularly at risk. (1–3) Population aging is a real concern for the surgical oncologists (4) who are treating patients who would not have been considered for surgery in the past. There is a strong association between increasing age, a cancer diagnosis, and the need for surgical intervention. Therefore the identification of pre-surgical risk factors and those patients at higher risk of POD as well as indentifying prophylactic measures aimed at reducing POD emergence, and targeted therapies for POD are especially important. Prevention has been shown to be the most effective strategy for minimizing the occurrence of delirium as well as delirium-associated complications. (5) Therefore prevention of delirium in older adults undergoing surgery is a top research priority given the extent of the problem in this patient population. In this review, we will describe the POD syndrome, previously identified risk factors that predict POD in surgical cancer patients, long-term outcomes of POD and both non-pharmacologic and pharmacologic therapies aimed at preventing POD.

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Section: Prevention Of Delirium: Pharmacological Interventionsmentioning

confidence: 99%

Prevention of post-operative delirium in older patients with cancer undergoing surgery

Korc‐Grodzicki

Root

Alici

2015

Journal of Geriatric Oncology

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“…Five double-blind randomized controlled trials of cholinesterase inhibitors have been published; three with donepezil and two with rivastigmine. ( 19 , 20 , 21 , 22 , 23 ) The total number of patients enrolled was 270. None of these studies found a significant reduction in the incidence of POD compared to placebo.…”

Section: Resultsmentioning

confidence: 99%

“…Similar conclusions were drawn from the two rivastigmine trials. ( 22 , 23 ) Gamberini et al . ( 23 ) published a double-blind, randomized, placebo-controlled trial where patients 65 years or older undergoing elective cardiac surgery (CABG and/or valve repair) were enrolled from February 2006 until July 2007 at the Division of Cardiac Surgery at the University Hospital Basel, Basel, Switzerland.…”

Section: Resultsmentioning

confidence: 99%

“…A transdermal patch of rivastigmine was used instead by Zaslavsky et al . ( 22 ) to bypass the enteral malabsorption encountered after a surgery. It was a randomized, placebo-controlled, double-blind clinical trial where patients of 65 years and older admitted for elective surgery under general anesthesia were screened.…”

Section: Resultsmentioning

confidence: 99%

“…( 31 ) Cholinesterase inhibitor prophylaxis has no positive effect on POD. ( 20 , 21 , 22 , 23 , 24 )…”

Section: Discussionmentioning

confidence: 99%

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Prevention of Post-operative Delirium in the Elderly Using Pharmacological Agents

Tremblay

Gold

2016

Can Geri J

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IntroductionPost-operative delirium (POD) is a serious surgical complication that can cause significant morbidity and mortality. It is associated with prolonged hospital stay, delayed admission to rehabilitation programs, persistent cognitive deficits, marked health-care costs, and more. The pathophysiology is multi-factorial and not completely understood, which complicates the optimal management. Non-pharmacological measures have been the mainstay of treatment, but there has been an ongoing interest in the medical literature on the prevention of post-operative delirium using medications. The purpose of this review is to critically analyze the current evidence on pharmacological prevention of POD.MethodsA literature review was conducted using PubMed and Embase databases, using the following search terms: delirium, anti-psychotics, cholinesterase inhibitors, and statins.ResultsA total of 1,152 articles were screened and 25 articles were reviewed. Fourteen articles found a reduced incidence of post-operative delirium using pharmacological agents: eight with antipsychotics, two with statins, one with melatonin, one with dexamethasone, one with gabapentin, and one with diazepam. However, study designs, methodological issues, or authors’ interpretations raise questions on these conclusions.ConclusionsFurther double-blinded randomized clinical trials should be conducted before administering pharmacological agents to reduce POD in a non-research setting.

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