Association of anesthetics with postoperative delirium in patients undergoing cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Jiali , HE Leilei , DAI Shunhui ,  YU Hai

Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

YU Hai, Email: yuhaishan117@yahoo.com

Keywords：

Cardiac surgery; delirium; intravenous anesthetic; propofol; inhalational anesthetic; sevoflurane; desflurane

DOI：

10.7507/1007-4848.202010045

Video：

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Objective To determine whether there was a clinical relevant association between anesthetic regimen (propofol or inhalational anesthetics) and the occurrence of postoperative delirium (POD) in patients undergoing cardiac surgery.Methods This retrospective study was conducted on patients with elective cardiac surgery under cardiopulmonary bypass (CPB) at West China Hospital of Sichuan University between October 2018 and March 2019. The patients were divided into a propofol group or an inhalational anesthetics group according to anesthetic regimen (including CPB). The primary outcome was the occurrence of POD during first 3 days after surgery. Logistic regression analysis was used to determine the relationship between anesthetic regimen and the occurrence of POD.Results A total of 197 patients who met the inclusion criteria were included, with an average age of 53 years, and 51.8% (102/197) were females. POD occurred in 21.3% (42/197) patients. The incidence of POD was 21.4% in the propofol group and 21.2% in the inhalational anesthetics group; there was no significant difference between the two groups (RR=1.01, 95%CI 0.51-2.00, P=0.970). Logistic regression analysis did not find that anesthetic regimen was a risk factor for delirium after cardiac surgery after adjusting risk factors (OR=1.05, 95%CI 0.48-2.32, P=0.900).Conclusion Anesthetic regimen (propofol or inhalational anesthetics) is not associated with an increased risk for POD in adult patients undergoing elective cardiac surgery under CPB.

Citation： JIANG Jiali, HE Leilei, DAI Shunhui, YU Hai. Association of anesthetics with postoperative delirium in patients undergoing cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(5): 565-570. doi: 10.7507/1007-4848.202010045 Copy

1.	Cereghetti C, Siegemund M, Schaedelin S, et al. Independent predictors of the duration and overall burden of postoperative delirium after cardiac surgery in adults: An observational cohort study. J Cardiothorac Vasc Anesth, 2017, 31(6): 1966-1973.
2.	Mufti HN, Hirsch GM. Perioperative prediction of agitated (hyperactive) delirium after cardiac surgery in adults — The development of a practical scorecard. J Crit Care, 2017, 42: 192-199.
3.	Lundström M, Edlund A, Karlsson S, et al. A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc, 2005, 53(4): 622-628.
4.	Quinlan N, Rudolph JL. Postoperative delirium and functional decline after noncardiac surgery. J Am Geriatr Soc, 2011, 59 (Suppl 2): S301-304.
5.	Abelha FJ, Luis C, Veiga D, et al. Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery. Crit Care, 2013, 17(5): R257.
6.	O' Brien H, Mohan H, Hare CO, et al. Mind over matter? The hidden epidemic of cognitive dysfunction in the older surgical patient. Ann Surg, 2017, 265(4): 677-691.
7.	Royse CF, Andrews DT, Newman SN, et al. The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery. Anaesthesia, 2011, 66(6): 455-464.
8.	Goins AE, Smeltz A, Ramm C, et al. General anesthesia for transcatheter aortic valve replacement: Total intravenous anesthesia is associated with less delirium as compared to volatile agent technique. J Cardiothorac Vasc Anesth, 2018, 32(4): 1570-1577.
9.	Jiao XF, Lin XM, Ni XF, et al. Volatile anesthetics versus total intravenous anesthesia in patients undergoing coronary artery bypass grafting: An updated meta-analysis and trial sequential analysis of randomized controlled trials. PLoS One, 2019, 14(10): e0224562.
10.	Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA, 2001, 286(21): 2703-2710.
11.	von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet, 2007, 370(9596): 1453-1457.
12.	Caplan JP, Chang G. Refeeding syndrome as an iatrogenic cause of delirium: A retrospective pilot study. Psychosomatics, 2010, 51(5): 419-424.
13.	Cerejeira J, Firmino H, Vaz-Serra A, et al. The neuroinflammatory hypothesis of delirium. Acta Neuropathol, 2010, 119(6): 737-754.
14.	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(7): 764-772.
15.	Siepe M, Pfeiffer T, Gieringer A, et al. Increased systemic perfusion pressure during cardiopulmonary bypass is associated with less early postoperative cognitive dysfunction and delirium. Eur J Cardiothorac Surg, 2011, 40(1): 200-207.
16.	Gosselt AN, Slooter AJ, Boere PR, et al. Risk factors for delirium after on-pump cardiac surgery: A systematic review. Crit Care, 2015, 19: 346.
17.	Martins S, Paiva JA, Simões MR, et al. Delirium in elderly patients: Association with educational attainment. Acta Neuropsychiatr, 2017, 29(2): 95-101.
18.	Järvelä K, Porkkala H, Karlsson S, et al. Postoperative delirium in cardiac surgery patients. J Cardiothorac Vasc Anesth, 2018, 32(4): 1597-1602.
19.	Jones D, Matalanis G, Mårtensson J, et al. Predictors and outcomes of cardiac surgery-associated delirium. A single centre retrospective cohort study. Heart Lung Circ, 2019, 28(3): 455-463.
20.	Guenther U, Theuerkauf N, Frommann I, et al. Predisposing and precipitating factors of delirium after cardiac surgery: A prospective observational cohort study. Ann Surg, 2013, 257(6): 1160-1167.
21.	Saczynski JS, Inouye SK, Kosar CM, et al. Cognitive and brain reserve and the risk of postoperative delirium in older patients: Analysis of data from a prospective observational study. Lancet Psychiatry, 2014, 1(6): 437-443.
22.	Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced recovery after surgery society recommendations. JAMA Surg, 2019, 154(8): 755-766.
23.	Matta BF, Lam AM, Strebel S, et al. Cerebral pressure autoregulation and carbon dioxide reactivity during propofol-induced EEG suppression. Br J Anaesth, 1995, 74(2): 159-163.
24.	Strebel S, Lam AM, Matta B, et al. Dynamic and static cerebral autoregulation during isoflurane, desflurane, and propofol anesthesia. Anesthesiology, 1995, 83(1): 66-76.
25.	Wang H, Lu S, Yu Q, et al. Sevoflurane preconditioning confers neuroprotection via anti-inflammatory effects. Front Biosci (Elite Ed), 2011, 3: 604-615.
26.	Likhvantsev VV, Landoni G, Levikov DI, et al. Sevoflurane versus total intravenous anesthesia for isolated coronary artery bypass surgery with cardiopulmonary bypass: A randomized trial. J Cardiothorac Vasc Anesth, 2016, 30(5): 1221-1227.
27.	Ovize M, Thibault H, Przyklenk K. Myocardial conditioning: Opportunities for clinical translation. Circ Res, 2013, 113(4): 439-450.
28.	De Hert S, Vlasselaers D, Barbé R, et al. A comparison of volatile and non volatile agents for cardioprotection during on-pump coronary surgery. Anaesthesia, 2009, 64(9): 953-960.
29.	Meco M, Cirri S, Gallazzi C, et al. Desflurane preconditioning in coronary artery bypass graft surgery: A double-blinded, randomised and placebo-controlled study. Eur J Cardiothorac Surg, 2007, 32(2): 319-325.

1. Cereghetti C, Siegemund M, Schaedelin S, et al. Independent predictors of the duration and overall burden of postoperative delirium after cardiac surgery in adults: An observational cohort study. J Cardiothorac Vasc Anesth, 2017, 31(6): 1966-1973.
2. Mufti HN, Hirsch GM. Perioperative prediction of agitated (hyperactive) delirium after cardiac surgery in adults — The development of a practical scorecard. J Crit Care, 2017, 42: 192-199.
3. Lundström M, Edlund A, Karlsson S, et al. A multifactorial intervention program reduces the duration of delirium, length of hospitalization, and mortality in delirious patients. J Am Geriatr Soc, 2005, 53(4): 622-628.
4. Quinlan N, Rudolph JL. Postoperative delirium and functional decline after noncardiac surgery. J Am Geriatr Soc, 2011, 59 (Suppl 2): S301-304.
5. Abelha FJ, Luis C, Veiga D, et al. Outcome and quality of life in patients with postoperative delirium during an ICU stay following major surgery. Crit Care, 2013, 17(5): R257.
6. O' Brien H, Mohan H, Hare CO, et al. Mind over matter? The hidden epidemic of cognitive dysfunction in the older surgical patient. Ann Surg, 2017, 265(4): 677-691.
7. Royse CF, Andrews DT, Newman SN, et al. The influence of propofol or desflurane on postoperative cognitive dysfunction in patients undergoing coronary artery bypass surgery. Anaesthesia, 2011, 66(6): 455-464.
8. Goins AE, Smeltz A, Ramm C, et al. General anesthesia for transcatheter aortic valve replacement: Total intravenous anesthesia is associated with less delirium as compared to volatile agent technique. J Cardiothorac Vasc Anesth, 2018, 32(4): 1570-1577.
9. Jiao XF, Lin XM, Ni XF, et al. Volatile anesthetics versus total intravenous anesthesia in patients undergoing coronary artery bypass grafting: An updated meta-analysis and trial sequential analysis of randomized controlled trials. PLoS One, 2019, 14(10): e0224562.
10. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA, 2001, 286(21): 2703-2710.
11. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. Lancet, 2007, 370(9596): 1453-1457.
12. Caplan JP, Chang G. Refeeding syndrome as an iatrogenic cause of delirium: A retrospective pilot study. Psychosomatics, 2010, 51(5): 419-424.
13. Cerejeira J, Firmino H, Vaz-Serra A, et al. The neuroinflammatory hypothesis of delirium. Acta Neuropathol, 2010, 119(6): 737-754.
14. 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(7): 764-772.
15. Siepe M, Pfeiffer T, Gieringer A, et al. Increased systemic perfusion pressure during cardiopulmonary bypass is associated with less early postoperative cognitive dysfunction and delirium. Eur J Cardiothorac Surg, 2011, 40(1): 200-207.
16. Gosselt AN, Slooter AJ, Boere PR, et al. Risk factors for delirium after on-pump cardiac surgery: A systematic review. Crit Care, 2015, 19: 346.
17. Martins S, Paiva JA, Simões MR, et al. Delirium in elderly patients: Association with educational attainment. Acta Neuropsychiatr, 2017, 29(2): 95-101.
18. Järvelä K, Porkkala H, Karlsson S, et al. Postoperative delirium in cardiac surgery patients. J Cardiothorac Vasc Anesth, 2018, 32(4): 1597-1602.
19. Jones D, Matalanis G, Mårtensson J, et al. Predictors and outcomes of cardiac surgery-associated delirium. A single centre retrospective cohort study. Heart Lung Circ, 2019, 28(3): 455-463.
20. Guenther U, Theuerkauf N, Frommann I, et al. Predisposing and precipitating factors of delirium after cardiac surgery: A prospective observational cohort study. Ann Surg, 2013, 257(6): 1160-1167.
21. Saczynski JS, Inouye SK, Kosar CM, et al. Cognitive and brain reserve and the risk of postoperative delirium in older patients: Analysis of data from a prospective observational study. Lancet Psychiatry, 2014, 1(6): 437-443.
22. Engelman DT, Ben Ali W, Williams JB, et al. Guidelines for perioperative care in cardiac surgery: Enhanced recovery after surgery society recommendations. JAMA Surg, 2019, 154(8): 755-766.
23. Matta BF, Lam AM, Strebel S, et al. Cerebral pressure autoregulation and carbon dioxide reactivity during propofol-induced EEG suppression. Br J Anaesth, 1995, 74(2): 159-163.
24. Strebel S, Lam AM, Matta B, et al. Dynamic and static cerebral autoregulation during isoflurane, desflurane, and propofol anesthesia. Anesthesiology, 1995, 83(1): 66-76.
25. Wang H, Lu S, Yu Q, et al. Sevoflurane preconditioning confers neuroprotection via anti-inflammatory effects. Front Biosci (Elite Ed), 2011, 3: 604-615.
26. Likhvantsev VV, Landoni G, Levikov DI, et al. Sevoflurane versus total intravenous anesthesia for isolated coronary artery bypass surgery with cardiopulmonary bypass: A randomized trial. J Cardiothorac Vasc Anesth, 2016, 30(5): 1221-1227.
27. Ovize M, Thibault H, Przyklenk K. Myocardial conditioning: Opportunities for clinical translation. Circ Res, 2013, 113(4): 439-450.
28. De Hert S, Vlasselaers D, Barbé R, et al. A comparison of volatile and non volatile agents for cardioprotection during on-pump coronary surgery. Anaesthesia, 2009, 64(9): 953-960.
29. Meco M, Cirri S, Gallazzi C, et al. Desflurane preconditioning in coronary artery bypass graft surgery: A double-blinded, randomised and placebo-controlled study. Eur J Cardiothorac Surg, 2007, 32(2): 319-325.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Association of anesthetics with postoperative delirium in patients undergoing cardiac surgery

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