Haloperidol prophylaxis for preventing aggravation of postoperative delirium in elderly patients: a randomized, open-label prospective trial

Fukata, Shinji; Kawabata, Y; Fujishiro, Ken; Kitagawa, Yuichi; Kuroiwa, Koichi; Akiyama, Hirotoshi; Takemura, Marie; Ando, Masahiko; Hattori, Hideyuki

doi:10.1007/s00595-016-1441-2

Cited by 26 publications

(19 citation statements)

References 59 publications

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“…Most studies reported the incidence of delirium for seven days after surgery. Three studies reported the incidence up to 6 weeks 5 , 16 , 17 , and 14 studies reported the incidence during hospital or ICU stay without reporting any specific period (Supplemental Table S1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Many pharmacologic agents were evaluated to prevent delirium after cardiac or non-cardiac surgery in previous studies. The agents included dexmedetomidine 2 – 4 , clonidine, other sedatives such as midazolam, ketamine and propofol, typical antipsychotics including haloperidol 5 – 7 , atypical antipsychotics including olanzapine and risperidone 8 , gabapentin 9 , pregabalin, steroid such as dexamethasone, and acetylcholinesterase inhibitor such as rivastigmine 10 . However, previous studies reported varying results from beneficial effect to potential harm.…”

Section: Introductionmentioning

confidence: 99%

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Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis

Park

Lim

Cho

et al. 2021

Sci Rep

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Many pharmacologic agents were investigated for the effect to prevent delirium. We aimed to comprehensively compare the effect of the pharmacological interventions to prevent postoperative delirium. A Bayesian network meta-analysis of randomized trials was performed using random effects model. PubMed, the Cochrane Central Register of Controlled Trials, and Embase were searched on 20 January 2021. Randomized trials comparing the effect of a drug to prevent postoperative delirium with another drug or placebo in adult patients undergoing any kind of surgery were included. Primary outcome was the postoperative incidence of delirium. Eighty-six trials with 26,992 participants were included. Dexmedetomidine, haloperidol, and atypical antipsychotics significantly decreased the incidence of delirium than placebo [dexmedetomidine: odds ratio 0.51, 95% credible interval (CrI) 0.40–0.66, moderate quality of evidence (QOE); haloperidol: odds ratio 0.59, 95% CrI 0.37–0.95, moderate QOE; atypical antipsychotics: odds ratio 0.27, 95% CrI 0.14–0.51, moderate QOE]. Dexmedetomidine and atypical antipsychotics had the highest-ranking probabilities to be the best. However, significant heterogeneity regarding diagnostic time window as well as small study effects precludes firm conclusion.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis

Park

Lim

Cho

et al. 2021

Sci Rep

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“…In the next study, the same authors [53] used an increased dose of haloperidol (5 mg intravenously) in 201 patients aged 75+ undergoing surgery, abdominal and orthopedic surgery, under general or regional anesthesia. Prophylaxis was used from zero to five days after surgery.…”

Section: Haloperidolmentioning

confidence: 99%

“…The oral route of treatment may not be optimal in selected groups of patients, e.g., those undergoing gastrointestinal surgery. In addition, both routes may show significant differences in drug bioavailability [53]. Zhang et al attempted to standardize the dosage by converting each study drug into an equivalent oral dose of haloperidol, but this effect is at high risk of error, especially in patients hospitalized in the ICU postoperatively [24].…”

Section: Limitationsmentioning

confidence: 99%

Antipsychotic Drugs in Prevention of Postoperative Delirium—What Is Known in 2020?

Pluta

Dziech

Czempik

et al. 2020

IJERPH

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Delirium is one of the most frequently reported neuropsychiatric complications in the perioperative period, especially in the population of elderly patients who often suffer from numerous comorbidities undergoing extensive or urgent surgery. It can affect up to 80% of patients who require hospitalization in an intensive care setting postoperatively. Delirium increases mortality, morbidity, length of hospital stay, and cost of treatment. An episode of delirium in the acute phase may lower the general quality of life and increases the risk of cognitive decline long-term. Since pharmacological treatment of delirium is not highly effective, focus of research has shifted towards developing preventive strategies. We aimed to perform a review of the topic based on the most recent literature. We conclude that, based on the available data, it seems impossible to make strong recommendations for using antipsychotic drugs in prophylaxis. Further research should answer the question what, if any, benefit patients receive from the pharmacological prevention of delirium, and which agents should be used.

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“…For example, patients who have recently had head and neck surgery [93] or procedures with large amounts of noxious stimulation (e.g., thoracotomy [94]) may be at increased risk for postoperative delirium; in these populations, preemptive analgesia, and regional techniques are likely to confer benefits. Other strategies have been suggested as potential improvements for managing a patient at high risk for postoperative delirium, including the use of short-acting medications [95], alternative anesthetic plans (e.g., regional [96], TIVA with dexmedetomidine [97, 98]), and pre-emptive anti-psychotic medication [99]. Unfortunately, none of these can be universally applied to patients at risk for delirium because the etiology of delirium is so variable.…”

Section: Perioperative Management Strategies For Postoperative Deliriummentioning

confidence: 99%

An Update on Postoperative Delirium: Clinical Features, Neuropathogenesis, and Perioperative Management

Safavynia

Arora

Pryor

et al. 2018

Curr Anesthesiol Rep

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Purpose of Review We present a focused review on postoperative delirium for anesthesiologists, encompassing clinical features, neuropathogenesis, and clinical identification and management strategies based on risk factors and current delirium treatments. Recent Findings The literature on postoperative delirium is dominated by non-experimental studies. We review delirium phenotypes, diagnostic criteria, and present standard nomenclature based on current literature. Disruption of cortical integration of complex information (CICI) may provide a framework to understand the neuropathogenesis of postoperative delirium, as well as risk factors and clinical modifiers in the perioperative period. We further divide risk factors into patient factors, surgical factors, and medical/pharmacological factors, and present specific considerations for each in the preoperative, intraoperative, and postoperative periods. Summary Postoperative delirium is prevalent, poorly understood, and often missed with current screening techniques. Proper identification of risk factors is useful for perioperative interventions and can help tailor patient-specific management strategies.

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Haloperidol prophylaxis for preventing aggravation of postoperative delirium in elderly patients: a randomized, open-label prospective trial

Abstract: The prophylactic administration of haloperidol at the early stage of delirium significantly reduced the incidence of severe postoperative delirium in elderly patients. Clinical Trial Registration UMIN000007204.

Cited by 26 publications

References 59 publications

Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis

Comparative effectiveness of pharmacological interventions to prevent postoperative delirium: a network meta-analysis

Antipsychotic Drugs in Prevention of Postoperative Delirium—What Is Known in 2020?

An Update on Postoperative Delirium: Clinical Features, Neuropathogenesis, and Perioperative Management

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