Key result
Pharmacological agents lack sufficient evidence for routine post-operative delirium prevention due to methodological flaws.
Why the study?
Do pharmacological agents prevent post-operative delirium in elderly patients?
Do pharmacological agents prevent post-operative delirium in elderly patients?
Current evidence for pharmacological prevention of post-operative delirium is limited by methodological issues, necessitating further double-blinded randomized clinical trials before routine clinical use.
Answers are grounded in this paper and cite their sources.
Current evidence does not support routine pharmacological prevention of post-operative delirium; leaves open whether rigorous RCTs can identify effective agents.
INTRODUCTION: Post-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. METHODS: A literature review was conducted using PubMed and Embase databases, using the following search terms: delirium, anti-psychotics, cholinesterase inhibitors, and statins. RESULTS: A 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. CONCLUSIONS: Further double-blinded randomized clinical trials should be conducted before administering pharmacological agents to reduce POD in a non-research setting.
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Tremblay et al. (2016) conducted a review in Post-operative delirium. Pharmacological agents (antipsychotics, cholinesterase inhibitors, statins, melatonin, etc.) vs. Placebo or standard care was evaluated on Incidence of post-operative delirium. Although 14 of 25 reviewed studies found pharmacological agents reduced post-operative delirium incidence, methodological limitations prevent recommending their routine use outside of research settings.
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