Department of Pharmacy, Zikei Hospital, Zikei Institute of Psychiatry, 100-2 Urayasu Honmachi, Minami-Ku, Okayama-shi, Okayama, 702-8508, Japan.
Department of Pharmacy, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo, 193-0988, Japan.
Eur J Clin Pharmacol. 2024 Dec;80(12):1883-1892. doi: 10.1007/s00228-024-03748-9. Epub 2024 Sep 12.
The effects of first-generation antihistamines in preventing postoperative emergence agitation or delirium are unclear. Determining the postoperative effects of first-generation antihistamines may provide important insights into the management of patient safety. Therefore, we performed a systematic review of randomized controlled trials (RCTs) evaluating the efficacy and safety of postoperative first-generation antihistamines.
Patients who used first-generation antihistamines in the intensive care unit or operating room were included. Primary outcomes were assessed postoperative emergence agitation or delirium with binary and continuous variables. The secondary outcome was any adverse event.
Nine studies were included. The frequency of postoperative emergence agitation, measured using binary variables, tended to be lower in patients receiving chlorpheniramine or diphenhydramine than those receiving saline. However, evaluation using the Richmond Agitation-Sedation Scale as a continuous variable revealed that only chlorpheniramine was effective at lowering postoperative emergence agitation. Only one study assessed delirium but found no benefit of first-generation antihistamines. Adverse events for first-generation antihistamines did not differ from that of other drugs.
Our results provide limited evidence that some first-generation antihistamines may prevent postoperative emergence agitation and are safe. To further verify this possibility, new RCTs with clear and universal assessment criteria for postoperative emergence agitation or delirium should be conducted.
第一代抗组胺药预防术后苏醒期躁动或谵妄的效果尚不清楚。确定第一代抗组胺药的术后效果可能为患者安全管理提供重要的见解。因此，我们对评估术后第一代抗组胺药疗效和安全性的随机对照试验（RCT）进行了系统评价。
纳入在重症监护病房或手术室使用第一代抗组胺药的患者。主要结局是使用二分类和连续变量评估术后苏醒期躁动或谵妄。次要结局是任何不良事件。
共纳入 9 项研究。使用二分类变量衡量的术后苏醒期躁动发生率，接受氯苯那敏或苯海拉明的患者比接受生理盐水的患者低，但使用Richmond 躁动-镇静量表作为连续变量评估时，只有氯苯那敏可有效降低术后苏醒期躁动。仅有一项研究评估了谵妄，但未发现第一代抗组胺药的获益。第一代抗组胺药的不良事件与其他药物无差异。
我们的结果提供了有限的证据表明，一些第一代抗组胺药可能预防术后苏醒期躁动，且安全。为了进一步验证这种可能性，应开展具有明确和通用的术后苏醒期躁动或谵妄评估标准的新 RCT。
