Affiliation:
1. Department of Anesthesiology Clinical Research Development Center Imam Hossein Educational Hospital Faculty of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
2. Sleep Disorders Center University of Maryland Medical Center Baltimore Maryland USA
3. Department of Anesthesiology Critical Care Quality Improvement Research Center at Shahid Modarres Hospital Shahid Beheshti University of Medical Sciences Tehran Iran
4. Department of Anesthesiology Anesthesiology Research Center Faculty of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran
Abstract
AbstractBackgroundDelirium is an acute and transient disorder of brain function that often occurs in post‐surgical patients. Rivastigmine is a cholinesterase inhibitor drug that has been proposed as an adjuvant drug in recent years, still, despite significant theoretical evidence, few clinical studies have been performed on its impact on delirium.AimDue to the widespread use of cholinesterase inhibitors in pediatric and adult surgery, the present study aims to investigate the impact of Rivastigmine as a cholinesterase inhibitor on delirium after radical surgery.MethodsIn this randomized double‐blind clinical trial, a hundred recruited patients were randomly assigned to either Rivastigmine (n = 50) or placebo (n = 50) groups, and we measured post‐operative impact on delirium, by Confusion Assessment Method (CAM) score, and cognitive impairment, by the Mini‐Mental State Examination (MMSE). Our univariate and multivariate logistical regression models assessed this hypothesized impact.ResultsTreatment with Rivastigmine was significantly associated with reduced day one post‐op delirium, as measured by CAM score (Odds Ratio (OR) = 0.35, 95% Confidence Interval (CI) 0.11 to 0.97, p = 0.05), and cognitive impairment, as measured by MMSE (OR = 0.25, 95% CI 0.1 to 0.59, p = 0.0022). These associations became stronger after controlling for age, blood loss, and post‐op blood sodium levels: Delirium (OR = 0.23, 95% CI 0.05 to 0.92, p = 0.05), cognitive impairment (OR = 0.12, 95% CI 0.03 to 0.42, p = 0.000178).ConclusionThe significant result of our randomized clinical trial is that pre‐op Rivastigmine treatment may be associated with a substantial drop in patients experiencing post‐op delirium and post‐op cognitive impairment.
Subject
Psychiatry and Mental health,Geriatrics and Gerontology