Comparison of the effect of haloperidol versus dexmedetomidine in the prevention of delirium after cardiac surgeries

Abstract

The high prevalence of delirium after heart surgery and its negative impact on patients' health pointed the importance of its prevention. The purpose of this study is to investigate and compare haloperidol versus dexmedetomidine in the prevention of delirium after cardiac surgery.

Methods: After obtaining the approval of the Ethics Committee of Tabriz University of Medical Sciences and obtaining written informed consent from all patients, 180 adult patients candidates of elective cardiac surgery with cardiopulmonary bypass in Shahid Madani Heart Hospital entered to this study. The patients were randomly allocated in the haloperidol or dexmedetomidine groups (n=90). A colleague’s coworker was responsible for preparing the treatment drug and had no role in the administration of anesthesia and data collection. Preoperative preparation methods, induction and maintenance of anesthesia and administration of cardiopulmonary bypass in all patients were run routinely without any intervention. Anesthesia was induced with fentanyl, midazolam and cisatracurium, and anesthesia was maintained with fentanyl, midazolam and cisatracurium infusion. At the end of surgery, according to the hospital routine, all patients were admitted to the cardiac surgery ICU while were intubated. For all patients, as soon as they were admitted to ICU, the treatment drug was started. The treatment drug in both groups included a loading dose and then infusion. The bolus drug in the haloperidol group was 2.5 mg of haloperidol and in the dexmedetomidine group contained 0.6 micrograms per kilogram of body weight, dexmedetomidine, which was infused in a 10 minutes period. Then infusion was started, (haloperidol 5 mg or dexmedetomidine 8 micrograms per kilogram of body weight diluted in a 40 cc syringe) and continued at a rate of 4 cc per hour for 12 hours. During ICU stay, the occurrence of delirium surveyed, using CAM_ICU tool. During ICU stay the demographic and basic data due to the operation and cardiopulmonary bypass, hemodynamic status, drug support, amount of bleeding in the first 24 hours, morbidity, duration of mechanical ventilation, ICU stay were recorded. Finally, the delirium incidence and other data compared between two groups, and the possible role of the demographic and other parameters in the incidence of delirium were investigated.

Results: The distribution of demographic data, underlying diseases, type of operation, duration of operation and cardiopulmonary bypass, and the amount of bleeding in the first 24 hours were the same in the two groups. However, the duration of mechanical ventilation and ICU stay in haloperidol group was less than that of the dexmedetomidine group (p<0.05). Delirium was diagnosed in 65 patients (36.51%). The incidence of delirium in the haloperidol group was less than that of the dexmedetomidine group. [22 patients (24.71%) versus 43 patients (48.31%), p=0.001]. In addition, comparing the patients with delirium to patients without delirium, the patients with delirium were older, and had lower left ventricular ejection fraction, increased duration of surgery and cardiopulmonary bypass, more bleeding in the first 24 hours and blood products consumption, more mechanical ventilation time and ICU stay.