Anestéziológia a intenzívna medicína 2/2014

Exogenous administration of melatonin in the prevention of postoperative delirium in cardiac surgery patients

This original article represents prospective clinical observational study. Post cardiac surgery delirium is a severe complication. The circadian rhythm of melatonin secretion has shown to be altered postoperatively. Delirium and perioperative sleep disturbance are potentially linked. It was hypothesized that by restoring normal sleeping patterns with a substance that is capable of resynchronizing circadian rhythm such as exogenous administration of melatonin may possibly reduce the incidence of postoperative delirium. Two consecutive groups of 250 consecutive patients took part in the study. The first was the control group and the second was the melatonin group. In second group, the patients received prophylactic melatonin treatment the evening before operation until postoperative day 3. The main objective of the clinical study was to observe the incidence of delirium and to identify any predictors of delirium and to compare the two groups based on the delirium incidence. The incidence of the delirium was 8.4% in melatonin group versus 20.8% in control group (p=0.001). Predictors of delirium in melatonin group were age (p=0.001) and higher EuroSCORE II value (p=0.001). In multivariate analysis of age and EuroSCORE II (p=0.014) by comparing the group together main predictors of delirium were age (p=0.001), EuroSCORE II (p=0.001), CPB time (p=0.001), ACC time (p=0.008), sufentanil dose (p=0.001), mechanical ventilation (p=0.033). The administration of melatonin significantly decreases the incidence of postoperative delirium after cardiac surgery. Prophylactic treatment with melatonin should be considered in every patient scheduled for cardiac surgery.

Keywords: melatonin, prevention, postoperative delirium, cardiac surgery.