Reduction in the rate of postoperative delirium by switching from famotidine to omeprazole in Japanese hepatectomized recipients

Abstract

Background Hepatectomy is a highly invasive procedure with a high probability of postoperative delirium. Treatment with antiulcer drugs is indispensable after hepatectomy for anastomotic ulcer management. The clinical pathway for hepatectomy was reviewed and the antiulcer drug used was switched from famotidine, a H 2 -receptor antagonist, to omeprazole, a proton pump inhibitor, owing to the pharmacist’s intervention. Methods Hepatectomized recipients over 65 years of age, except in the cases of laparoscopic surgery and intensive care unit entry, were treated with famotidine injections (10 patients) or omeprazole injections (11 patients), and the incidence rates and severity of delirium were compared between the famotidine and omeprazole groups. The delirium after hepatectomy was assessed using the Japanese version of the NEECHAM confusion scale. Results The incidence rates of delirium were 90% in the famotidine group and 27.3% in the omeprazole group. Four out of 9 recipients in the famotidine group were injected with haloperidol to treat for delirium, but no recipients needed this treatment in the omeprazole group. Conclusions Compared with famotidine, the use of omeprazole was found to be effective in reducing the incidence rate and severity of postoperative delirium in patients undergoing hepatectomy. Pharmacists should actively strive to mitigate the risks of delirium.

Histamine receptors and COVID-19

“…This was reviewed in 1991 where central nervous system reactions including delirium were attributed to H 2 receptor antagonists [ 75 ]. Discontinuing H 2 antagonist treatment in patients who have developed delirium alleviates the symptoms in a number of clinical settings [ 76 , 77 ].…”

Association of Histamine-2 Blockers and Proton-Pump Inhibitors With Delirium Development in Critically Ill Adults: A Retrospective Cohort Study

“…In a prospective study of 21 Japanese hepatectomized recipients, patients were randomized to treatment with either famotidine or omeprazole for postoperative ulcer management. The incidence rates and severity of delirium were significantly higher in the famotidine group (90%) than the omeprazole group (27.3.%) (odds ratio, 3.82; 1.15-12.71; p < 0.01) (18). The second study retrospectively studied rates of delirium in 60 postsurgical esophageal cancer patients treated with either H2RAs or PPIs for ulcer prevention.…”

“…Prior retrospective studies have demonstrated greater prevalence of delirium in critically ill patients taking H2RAs rather than PPIs and have reported reduced delirium severity after patients taking H2RAs were switched to PPIs (15)(16)(17)(18)(19). These studies are limited in number and have low generalizability due to strict inclusion criteria and small sample size.…”