Prophylaxis of dexamethasone protects patients from further post-operative delirium after cardiac surgery: A randomized trial

Abstract

Background: Coronary artery bypass graft is one of common cardiac surgeries which unfortunately accompany with some adverse events such as delirium. Proinflammatory processes play an important role in pathogenesis of post-operative delirium. Therefore, the effect of dexamethasone (DEX) on post-operative delirium after cardiac surgery was evaluated.

Materials and methods: This randomized clinical trial study was conducted with objective of evaluation of DEX effects on post-operative deliriums and complications after cardiac surgery. Ninety three eligible patients who undergone coronary arteries bypass graft was divided into two groups of DEX with 43 patients and placebo (PCB) with 50 patients. DEX group taken 8 mg DEX intra-venous before induction of anesthesia followed by 8 mg every 8 h for 3 day and other group received PCB in same way.

Results: All patients assessed by Mini-mental status questionnaire and psychiatric interviewing with aim of diagnosing delirium. Extubation time of DEX group was significantly reduced. The first post-operative day deliriums, extubation time, hospital, and intensive-care unit length of stay significantly reduced in DEX group without increasing serious complications such as infectious disease. After administration of DEX only hyperglycemia as an adverse event was increased in DEX group. Other complications of renal, cardiac, cerebrovascular and respiratory system did not show any significant differences between groups.

Conclusion: Pre-operative administration of DEX might safely protect brain of the patients who undergone cardiac surgery against post-operative delirium.

Keywords: Cardiac surgery; clinical trial; delirium; dexamethasone.