A study reveals that acetaminophen dramatically reduces delirium at the hospital

Nearly half of patients who undergo cardiac surgery may experience delirium, a form of acute confusion that can lead to disorientation, memory impairment, delusions, and sudden changes in mood and behavior, including aggression. .

In a new study published in the Journal of the American Medical Association, a physician researcher at the Beth Israel Deaconess Medical Center, found that intravenous acetaminophen significantly reduced the incidence of postoperative delirium after CABG in patients over 60 years of age. The results of this monocentric trial could constitute the first steps of a therapeutic intervention for treatment. prevention of postoperative delirium, a frequent and devastating complication in the elderly, often very vulnerable, who undergo cardiac surgery.

"Currently, the administration of intravenous acetaminophen is considered an expensive procedure, and the management of pain after cardiac surgery varies greatly," said corresponding author, Balachundhar Subramainam, MD , Ph.D., director of the Center for Research on Anesthesia. Anesthesia, Critical Care and Pain Medicine at BIDMC. "If our findings are replicated as part of a larger multicenter study, intravenous intravenous acetaminophen administration could become a standard of care in all cardiac surgery patients and could be integrated." in recovery protocols for cardiac surgery ".

Subramaniam and his colleagues recruited 120 patients aged 60 years or older who underwent coronary bypbad with or without valve repair at the Beth Israel Deaconess Medical Center in Boston between September 2015 and April 2018. To evaluate the effect of the 39, intravenous acetaminophen on postoperative delirium, the investigators have the patients were divided into one of four groups receiving different combinations of sedation and pain medication after surgery: 29 participants received sedative dexmedetomidine with intravenous acetaminophen, while 30 participants received dexmedetomidine and placebo. Thirty-one patients received sedative propofol in combination with acetaminophen and 30 received propofol with placebo.

Patients treated with acetaminophen exhibited a significant reduction in delirium at the hospital. Only 10% of the acetaminophen group showed signs of delirium, compared with 28% of those on placebo. In addition, patients treated with acetaminophen were also more likely to have shorter stays in the intensive care unit and less pain following an acute onset. Delirious patients had shorter episodes of acute confusion.

In addition to reducing the incidence of delirium, the addition of acetaminophen to postoperative care also reduced the need for opioid badgesics in these patients, Subramaniam added.

"It is known that postoperative pain increases the risk of postoperative delirium, as does the use of opioids to manage postoperative pain," he said. "We found that the use of intravenous acetaminophen effectively controlled pain and that we had found a clear opioid economy during the postoperative period, with a reduction in the duration of delirium and length of stay in the intensive care unit. "

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Beth Israel Deaconess Medical Center