Haloperidol prophylaxis of postoperative delirium after cardiac surgery

Abstract

The aim of this study is to investigation of Haloperidol prophylaxis of postoperative delirium after cardiac surgery. Materials and Methods: In this study, which was performed as a clinical trial, the target population included adult patients over 18 years of age and candidates for elective cardiac surgery with the help of a cardiopulmonary pump at Shahid Madani Hospital in Tabriz in 2019. After obtaining the approval of the ethics committee of Tabriz University of Medical Sciences and obtaining informed written consent from all patients, 170 patients were randomly assigned to one of the two groups of 85 people haloperidol or placebo according to the prepared list. Immediately after the onset of cardiopulmonary bypass (CPB), according to the randomization list, in patients in the haloperidol or placebo group, 10 cc of haloperidol solution (5 mg) or the same volume of distilled water was injected intravenously, respectively. After admission to the ICU of cardiac surgery at one and thirteen hours, intravenous injections of 4 cc of treatment were repeated, which in the haloperidol group contained 2 mg of haloperidol. During hospitalization in the ICU, the incidence of delirium in both groups was monitored and recorded by CAM-ICU. In addition to recording demographic data, information about surgery, hemodynamic status, morbidity, duration of mechanical ventilation, ICU hospitalization and postoperative hospitalization, and hospital mortality were recorded and compared between the two groups. Results: The two groups were not different in terms of demographic variables including age, sex and BMI. The ejection fraction was the same in both groups and the distribution of underlying disease and types of surgeries and related variables intraoperative (operation time and CPB) and postoperative (need for cardiac drugs, complications and time of mechanical ventilation and hospitalization in ICU) were not significantly different between the two groups. The prevalence of delirium in total was 22.9% and in the two groups of haloperidol and placebo were 11.7% and 34.1%, respectively (P-value = 0.001). There was no association between preoperative ejection fraction and delirium (P-value = 0.284). The incidence of delirium was higher with increasing the duration of operation to more than 5.5 hours (41.8% vs. 13.9%) and increasing the duration of CPB use to more than 90 minutes (40% vs. 15.8%) (P-value<0.001). In aortic and ascending aortic surgeries, the amount of delirium was higher than other operations (46.7% vs. 20.6%, P-value = 0.047). There was no association between inotropic and vasodilator use and the prevalence of delirium; But in patients who needed noradrenaline, the amount of delirium was higher (32.7% vs. 17.4%, P-value = 0.035). In patients with delirium, the rate of bleeding in the first 24 hours, plasma intake of blood products, duration of mechanical ventilation, and length of hospital stay in the ICU were higher than in non-delirium patients.