Early treatment with risperidone for subsyndromal delirium after on-pump cardiac
surgery in the elderly: a randomized trial.
Author(s): Hakim SM, Othman AI, Naoum DO.
Affiliation(s): Department of Anesthesiology, Faculty of Medicine, Ain Shams University, Cairo,
Egypt. drsmichel@hotmail.com
Publication date & source: 2012, Anesthesiology. , 116(5):987-97
BACKGROUND: The aim of this randomized, parallel-arm trial was to study the
effect of treating subsyndromal delirium with risperidone on the incidence of
clinical delirium in elderly patients who underwent on-pump cardiac surgery.
METHODS: One hundred one patients aged 65 yr or older who experienced
subsyndromal delirium after on-pump cardiac surgery were randomized using a
computer-generated list to receive 0.5 mg risperidone (n = 51) or placebo (n =
50) every 12 h by mouth. Patients were assessed at 8 h by a blinded observer
using the Intensive Care Delirium Screening Checklist, and those scoring more
than 3 were evaluated by a blinded psychiatrist to confirm delirium. Patients in
either group who experienced delirium were treated according to the same
algorithm. Initially, risperidone was administered and if symptoms were not
controlled, haloperidol was administered. The primary outcome was the proportion
of patients who experienced delirium in either group.
RESULTS: Seven (13.7%) patients in the risperidone group experienced delirium
versus 17 (34%) in the placebo group (P = 0.031) Competing-risks regression
analysis showed that failure to treat subsyndromal delirium with risperidone was
an independent risk factor for delirium (subhazard ratio, 3.83; 95% CI,
1.63-8.98; P = 0.002). Two (3.9%) patients in the risperidone group experienced
extrapyramidal manifestations versus one (2%) in the placebo group (P = 1.0).
CONCLUSION: Administration of risperidone to elderly patients who experienced
subsyndromal delirium after on-pump cardiac surgery was associated with
significantly lower incidence of delirium. Larger studies are required to
determine whether early administration of risperidone during the subsyndromal
phase of delirium would influence the clinical course of such patients.
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