Preventive Effect of Suvorexant for Postoperative Delirium after Coronary Artery Bypass Grafting

Kiyoshi Tamura, Toshiyuki Maruyama, Syogo Sakurai, Kiyoshi Tamura, Toshiyuki Maruyama, Syogo Sakurai

Abstract

Objective: Suvorexant is an orexin receptor antagonist and is effective in inducing sleep. We hypothesized that Suvorexant would reduce the incidence of postoperative delirium (POD) after coronary artery bypass grafting (CABG).

Methods: We reviewed 88 patients (12 women, mean age: 69.3 ± 2.5 years) who were undergone CABG alone. Patients were divided into two groups; patients received Suvorexant (S group, n = 36), patients not received Suvorexant (N group, n = 52), and the following data were analyzed and compared between two groups.

Results: Intensive Care Unit Delirium Screening Checklist Score was significantly lower in S group compared with N group (N:S = 2.0 ± 1.7:0.8 ± 1.0, p = 0.0003). Although POD was present in 11 of 52 patients (21.2%) in N group, one patient (2.8%) developed in S group (p = 0.008). In S group, both intensive care unit stay (N:S = median 6:5 days, p = 0.001) and hospital stay (N:S = median 23:20 days, p = 0.035) were significantly shorter than in N group.

Conclusions: Suvorexant might reduce incidence of POD in patients undergone CABG.

Keywords: Suvorexant; coronary artery bypass grafting; orexin receptor antagonist; postoperative delirium.

References

    1. Rudolph JL, Inouye SK, Jones RN, et al. Delirium: an independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc 2010; 58: 643-9.
    1. Rudolph JL, Marcantonio ER. Review articles: postoperative delirium: acute change with long-term implications. Anesth Analg 2011; 112: 1202-11.
    1. Trabold B, Metterlein T. Postoperative delirium: risk factors, prevention, and treatment. J Cardiothorac Vasc Anesth 2014; 28: 1352-60.
    1. Pisani MA, Murphy TE, Van Ness PH, et al. Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med 2007; 167: 1629-34.
    1. Belsomra [package insert]. Kenilworth, NJ: Merck & Co., Inc; Revised August 2014.
    1. Sessler CN, Gosnell MS, Grap MJ, et al. The richmond agitation-sedation scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002; 166: 1338-44.
    1. Payen JF, Bru O, Bosson JL, et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001; 29: 2258-63.
    1. Bergeron N, Dubois MJ, Dumont M, et al. Intensive care delirium screening checklist: evaluation of a new screening tool. Intensive Care Med 2001; 27: 859-64.
    1. Selnes OA, McKhann GM, Borowicz LM, et al. Cognitive and neurobehavioral dysfunction after cardiac bypass procedures. Neurol Clin 2006; 24: 133-45.
    1. Saczynski JS, Marcantonio ER, Quach L, et al. Cognitive trajectories after postoperative delirium. N Engl J Med 2012; 367: 30-9.
    1. Hughes CG, Morandi A, Girard TD, et al. Association between endothelial dysfunction and acute brain dysfunction during critical illness. Anesthesiology 2013; 118: 631-9.
    1. Cerejeira J, Firmino H, Vaz-Serra A, et al. The neuroinflammatory hypothesis of delirium. Acta Neuropathol 2010; 119: 737-54.
    1. Young BK, Camicioli R, Ganzini L. Neuropsychiatric adverse effects of antiparkinsonian drugs. Characteristics, evaluation and treatment. Drugs Aging 1997; 10: 367-83.
    1. Hshieh TT, Fong TG, Marcantonio ER, et al. Cholinergic deficiency hypothesis in delirium: a synthesis of current evidence. J Gerontol A Biol Sci Med Sci 2008; 63: 764-72.
    1. Newman MF, Mathew JP, Grocott HP, et al. Central nervous system injury associated with cardiac surgery. Lancet 2006; 368: 694-703.
    1. McKhann GM, Grega MA, Borowicz LM, Jr, et al. Stroke and encephalopathy after cardiac surgery: an update. Stroke 2006; 37: 562-71.
    1. Grocott HP. Pharmacologic neuroprotection: the search continues. J Extra Corpor Technol 2007; 39: 296-301.
    1. Martin BJ, Buth KJ, Arora RC, et al. Delirium: a cause for concern beyond the immediate postoperative period. Ann Thorac Surg 2012; 93: 1114-20.
    1. Kawatani Y, Nakamura Y, Hayashi Y, et al. Development of delirium in the intensive care unit in patients after endovascular aortic repair: a retrospective evaluation of the prevalence and risk factors. Crit Care Res Pract 2015; 2015: 405817.
    1. Gaudreau JD, Gagnon P, Roy MA, et al. Association between psychoactive medications and delirium in hospitalized patients: a critical review. Psychosomatics 2005; 46: 302-16.
    1. Al Tmimi L, Van de Velde M, Herijgers P, et al. Xenon for the prevention of postoperative delirium in cardiac surgery: study protocol for a randomized controlled clinical trial. Trials 2015; 16: 449.
    1. Ma D, Yang H, Lynch J, et al. Xenon attenuates cardiopulmonary bypass-induced neurologic and neurocognitive dysfunction in the rat. Anesthesiology 2003; 98: 690-8.
    1. Deng J, Lei C, Chen Y, et al. Neuroprotective gases– fantasy or reality for clinical use? Prog Neurobiol 2014; 115: 210-45.
    1. Sironi L, Cimino M, Guerrini U, et al. Treatment with statins after induction of focal ischemia in rats reduces the extent of brain damage. Arterioscler Thromb Vasc Biol 2003; 23: 322-7.
    1. Page VJ, Davis D, Zhao XB, et al. Statin use and risk of delirium in the critically ill. Am J Respir Crit Care Med 2014; 189: 666-73.
    1. Morandi A, Hughes CG, Thompson JL, et al. Statins and delirium during critical illness: a multicenter, prospective cohort study. Crit Care Med 2014; 42: 1899-909.
    1. Sun H, Kennedy WP, Wilbraham D, et al. Effects of suvorexant, an orexin receptor antagonist, on sleep parameters as measured by polysomnography in healthy men. Sleep 2013; 36: 259-67.
    1. Hoyer D, Jacobson LH. Orexin in sleep, addiction and more: is the perfect insomnia drug at hand? Neuropeptides 2013; 47: 477-88.
    1. Hatta K, Kishi Y, Wada K, et al. Preventive effects of suvorexant on delirium: a randomized placebo-controlled trial. J Clin Psychiatry 2017; 78: e970-9.
    1. Booka E, Tsubosa Y, Matsumoto T, et al. Postoperative delirium after pharyngolaryngectomy with esophagectomy: a role for ramelteon and suvorexant. Esophagus 2017; 14: 229-34.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi