Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, 2176 Health Sciences Mall, Vancouver, B.C., Canada, V6T 1Z3.
Curr Neuropharmacol. 2012 Sep;10(3):181-96. doi: 10.2174/157015912803217332.
The objective of this review is to evaluate the literature on medications associated with delirium after cardiac surgery and potential prophylactic agents for preventing it.
Articles were searched in MEDLINE, Cumulative Index to Nursing and Allied Health, and EMBASE with the MeSH headings: delirium, cardiac surgical procedures, and risk factors, and the keywords: delirium, cardiac surgery, risk factors, and drugs. Principle inclusion criteria include having patient samples receiving cardiac procedures on cardiopulmonary bypass, and using DSM-IV-TR criteria or a standardized tool for the diagnosis of delirium.
Fifteen studies were reviewed. Two single drugs (intraoperative fentanyl and ketamine), and two classes of drugs (preoperative antipsychotics and postoperative inotropes) were identified in the literature as being independently associated with delirium after cardiac surgery. Another seven classes of drugs (preoperative antihypertensives, anticholinergics, antidepressants, benzodiazepines, opioids, and statins, and postoperative opioids) and three single drugs (intraoperative diazepam, and postoperative dexmedetomidine and rivastigmine) have mixed findings. One drug (risperidone) has been shown to prevent delirium when taken immediately upon awakening from cardiac surgery. None of these findings was replicated in the studies reviewed.
These studies have shown that drugs taken perioperatively by cardiac surgery patients need to be considered in delirium risk management strategies. While medications with direct neurological actions are clearly important, this review has shown that specific cardiovascular drugs may also require attention. Future studies that are methodologically consistent are required to further validate these findings and improve their utility.
本综述旨在评估与心脏手术后谵妄相关的药物以及预防该并发症的潜在预防药物的文献。
在 MEDLINE、Cumulative Index to Nursing and Allied Health 和 EMBASE 中使用“谵妄”、“心脏外科手术”和“风险因素”的 MeSH 标题以及“谵妄”、“心脏手术”、“风险因素”和“药物”的关键词进行了检索。主要纳入标准包括有接受体外循环心脏手术的患者样本，以及使用 DSM-IV-TR 标准或标准化工具诊断谵妄。
共审查了 15 项研究。文献中确定了两种单一药物（术中芬太尼和氯胺酮）和两种药物类别（术前抗精神病药和术后正性肌力药）与心脏手术后谵妄独立相关。另外七种药物类别（术前抗高血压药、抗胆碱能药、抗抑郁药、苯二氮䓬类、阿片类药物和他汀类药物以及术后阿片类药物）和三种单一药物（术中地西泮以及术后右美托咪定和利伐斯的明）具有混合结果。一种药物（利培酮）在心脏手术后从麻醉中醒来时立即服用可预防谵妄。在综述中没有重复这些发现。
这些研究表明，心脏手术患者围手术期使用的药物需要纳入谵妄风险管理策略。虽然具有直接神经作用的药物显然很重要，但本综述表明特定的心血管药物也可能需要注意。需要进行方法学一致的未来研究，以进一步验证这些发现并提高其实用性。
