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Effect of perioperative benzodiazepine use on intraoperative awareness and postoperative delirium: a systematic review and meta-analysis of randomised controlled trials and observational studies.
Wang, Eugene; Belley-Côté, Emilie P; Young, Jack; He, Henry; Saud, Haris; D'Aragon, Frederick; Um, Kevin; Alhazzani, Waleed; Piticaru, Joshua; Hedden, Matthew; Whitlock, Richard; Mazer, C David; Kashani, Hessam H; Zhang, Sarah Yang; Lucas, Amanda; Timmerman, Nicholas; Nishi, Cameron; Jain, Davinder; Kugler, Aaron; Beaver, Chris; Kloppenburg, Shelley; Schulman, Sam; Borges, Flavia K; Kavosh, Morvarid; Wada, Chihiro; Lin, Sabrina; Sibilio, Serena; Lauw, Mandy; Benz, Alexander; Szczeklik, Wojciech; Mokhtari, Arastoo; Jacobsohn, Eric; Spence, Jessica.
Afiliação
  • Wang E; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Belley-Côté EP; Departments of Medicine (Cardiology and Critical Care), McMaster University, Hamilton, ON, Canada; Perioperative Research Division, Population Health Research Institute, Hamilton, ON, Canada.
  • Young J; Health Sciences Library, McMaster University, Hamilton, ON, Canada.
  • He H; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Saud H; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • D'Aragon F; Départment d'anesthésiologie, Université de Sherbrooke, Quebec, QU, Canada.
  • Um K; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Alhazzani W; Departments of Critical Care, Medicine (Gastroenterology), and Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada.
  • Piticaru J; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Hedden M; Faculty of Arts and Science, Queen's University, Kingston, ON, Canada.
  • Whitlock R; Perioperative Research Division, Population Health Research Institute, Hamilton, ON, Canada; Departments of Surgery (Cardiac Surgery) and Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada.
  • Mazer CD; Department of Anesthesia and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada.
  • Kashani HH; Department of Anesthesia and Perioperative Medicine, University of Manitoba, Winnipeg, MB, Canada.
  • Zhang SY; Faculty of Medicine, McGill University, Montreal, QU, Canada.
  • Lucas A; Department of Health Research Methods, Evaluation, and Impact; McMaster University, Hamilton, ON, Canada.
  • Timmerman N; Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
  • Nishi C; Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
  • Jain D; Department of Anesthesiology, Trillium Health Partners, Toronto, ON, Canada.
  • Kugler A; Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
  • Beaver C; Sheridan College, Oakville, ON, Canada.
  • Kloppenburg S; Organon, Montreal, QU, Canada.
  • Schulman S; Department of Medicine (Hematology), McMaster University, Hamilton, ON, Canada; Thrombosis and Atherosclerosis Research Institute, Population Health Research Institute, Hamilton, ON, Canada; Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
  • Borges FK; Perioperative Research Division, Population Health Research Institute, Hamilton, ON, Canada; Departments of Medicine and Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada.
  • Kavosh M; Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA.
  • Wada C; Faculty of Arts, Waseda University, Tokyo, Japan.
  • Lin S; Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
  • Sibilio S; Division of Cardiac Surgery, Instituto Clinico Sant'Ambrogio, Milan, Italy; Division of Cardiac Surgery, Centre Hospitalière Universitaire de Lille, Lille, France.
  • Lauw M; Population Health Research Institute, Hamilton, ON, Canada.
  • Benz A; Population Health Research Institute, Hamilton, ON, Canada.
  • Szczeklik W; Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
  • Mokhtari A; Department of Medicine (Cardiology), McMaster University, Hamilton, ON, Canada.
  • Jacobsohn E; Departments of Anesthesia and Perioperative Medicine and Medicine (Critical Care), University of Manitoba, Winnipeg, MB, Canada.
  • Spence J; Perioperative Research Division, Population Health Research Institute, Hamilton, ON, Canada; Departments of Anesthesia and Critical Care and Health Research Methods, Evaluation, and Impact, McMaster University, Hamilton, ON, Canada. Electronic address: spencej@phri.ca.
Br J Anaesth ; 131(2): 302-313, 2023 08.
Article em En | MEDLINE | ID: mdl-36621439
ABSTRACT

BACKGROUND:

Benzodiazepine use is associated with delirium, and guidelines recommend avoiding them in older and critically ill patients. Their perioperative use remains common because of perceived benefits.

METHODS:

We searched CENTRAL, MEDLINE, CINAHL, PsycInfo, and Web of Science from inception to June 2021. Pairs of reviewers identified randomised controlled trials and prospective observational studies comparing perioperative use of benzodiazepines with other agents or placebo in patients undergoing surgery. Two reviewers independently abstracted data, which we combined using a random-effects model. Our primary outcomes were delirium, intraoperative awareness, and mortality.

RESULTS:

We included 34 randomised controlled trials (n=4354) and nine observational studies (n=3309). Observational studies were considered separately. Perioperative benzodiazepines did not increase the risk of delirium (n=1352; risk ratio [RR] 1.43; 95% confidence interval [CI] 0.9-2.27; I2=72%; P=0.13; very low-quality evidence). Use of benzodiazepines instead of dexmedetomidine did, however, increase the risk of delirium (five studies; n=429; RR 1.83; 95% CI 1.24-2.72; I2=13%; P=0.002). Perioperative benzodiazepine use decreased the risk of intraoperative awareness (n=2245; RR 0.26; 95% CI 0.12-0.58; I2=35%; P=0.001; very low-quality evidence). When considering non-events, perioperative benzodiazepine use increased the probability of not having intraoperative awareness (RR 1.07; 95% CI 1.01-1.13; I2=98%; P=0.03; very low-quality evidence). Mortality was reported by one randomised controlled trial (n=800; RR 0.90; 95% CI 0.20-3.1; P=0.80; very low quality).

CONCLUSIONS:

In this systematic review and meta-analysis, perioperative benzodiazepine use did not increase postoperative delirium and decreased intraoperative awareness. Previously observed relationships of benzodiazepine use with delirium could be explained by comparisons with dexmedetomidine. SYSTEMATIC REVIEW PROTOCOL PROSPERO CRD42019128144.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Dexmedetomidina / Delírio / Consciência no Peroperatório / Delírio do Despertar Idioma: En Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Canadá
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Dexmedetomidina / Delírio / Consciência no Peroperatório / Delírio do Despertar Idioma: En Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Canadá