The effect of dexamethasone prophylaxis on postoperative delirium after cardiac surgery: a randomized trial

Abstract

• BACKGROUND: Coronary artery bypass graft is commonly associated with post cardiac surgery delirium. Proinflammatory processes play an important role in the pathogenesis of postoperative delirium. Therefore, dexamethasone might have a beneficial effect on the reduction of this complication.
• METHODS: This randomized clinical trial was conducted with the objective of the evaluation of dexamethasone effects on postoperative delirium and complications after cardiac surgery. The eligible patients were divided into 2 groups of dexamethasone with 43 patients and placebo with 50 patients. The dexamethasone group took 8mg dexamethasone before induction of anesthesia followed by 8mg every 8 hour for 3 days and the other group received placebo in the same way.
• RESULTS: all patients were assessed by a mini mental status questionnaire and psychiatric interviewing with the aim of diagnosing delirium. Extubation time of the dexamethasone group was significantly reduced. Our results showed that in the first postoperative day delirium, extubation time, and intensive care unit length of stay significantly decreased in the dexamethasone group without increasing serious complications such as infectious diseases. After administration of dexamethasone only hyperglycemia as an adverse event was increased in the dexamethasone group. Other complications of renal, cardiac, cerebrovascular and respiratory system did not show any significant differences between the two groups.
• CONCLUSIONS: postoperative delirium is in correlation with costly adverse events after cardiac surgery. Our data suggested that preoperative administration of dexamethasone might safely protect the brain of patients who undergone cardiac surgery against postoperative delirium.
• KEYWORDS: Cardiopulmonary Bypass, Delirium, Coronary Artery Bypasses Grafting, Dexamethasone