Skip to main content
Erschienen in: Surgery Today 12/2020

08.07.2020 | Original Article

A phase II study of ramelteon for the prevention of postoperative delirium in elderly patients undergoing gastrectomy

verfasst von: Shinsaku Honda, Kenichiro Furukawa, Rie Makuuchi, Tomoyuki Irino, Masanori Tokunaga, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, Kaori Shinsato, Teruaki Matsumoto, Masanori Terashima

Erschienen in: Surgery Today | Ausgabe 12/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The growing number of cases of gastric cancer being diagnosed in elderly patients highlights the importance of preventing postoperative delirium. This phase II study aimed to evaluate the efficacy of perioperative treatment with ramelteon for preventing postoperative delirium in elderly patients undergoing gastrectomy.

Methods

This study was designed as a single-institute prospective phase II study. Patients ≥ 75 years old were eligible. Ramelteon 8 mg/day was administered from 8 days before the operation until discharge. Postoperative delirium was evaluated using the Confusion Assessment Method-Intensive Care Unit flow sheet.

Results

Between September 2015 and July 2017, a total of 83 patients were enrolled, 76 of whom were eligible and included in the analysis. Postoperative delirium was observed in four patients (5%) (60% confidence interval: 3.0–8.7). The upper margin of the confidence interval was lower than the prespecified threshold of 13%; therefore, the null hypothesis was rejected.

Conclusion

This phase II study suggested that the perioperative administration of ramelteon is safe and feasible for preventing postoperative delirium in elderly patients undergoing gastrectomy.
Trial registration This study was registered at UMIN (UMIN 000018697)
Literatur
1.
Zurück zum Zitat American Psychiatric A. American Psychiatric Association DSMTF. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Philadelphia: American Psychiatric Pub.; 2013. American Psychiatric A. American Psychiatric Association DSMTF. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Philadelphia: American Psychiatric Pub.; 2013.
2.
Zurück zum Zitat Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22.PubMed Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22.PubMed
3.
Zurück zum Zitat Bin Abd Razak HR, Yung WY. Postoperative delirium in patients undergoing total joint arthroplasty: a systematic review. J Arthroplasty. 2015;30(8):1414–7.PubMed Bin Abd Razak HR, Yung WY. Postoperative delirium in patients undergoing total joint arthroplasty: a systematic review. J Arthroplasty. 2015;30(8):1414–7.PubMed
4.
Zurück zum Zitat Postler A, Neidel J, Gunther KP, Kirschner S. Incidence of early postoperative cognitive dysfunction and other adverse events in elderly patients undergoing elective total hip replacement (THR). Arch Gerontol Geriatr. 2011;53(3):328–33.PubMed Postler A, Neidel J, Gunther KP, Kirschner S. Incidence of early postoperative cognitive dysfunction and other adverse events in elderly patients undergoing elective total hip replacement (THR). Arch Gerontol Geriatr. 2011;53(3):328–33.PubMed
5.
Zurück zum Zitat Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443–51.PubMed Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304(4):443–51.PubMed
6.
Zurück zum Zitat Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International study of post-operative cognitive dysfunction. Lancet. 1998;351(9106):857–61.PubMed Moller JT, Cluitmans P, Rasmussen LS, Houx P, Rasmussen H, Canet J, et al. Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International study of post-operative cognitive dysfunction. Lancet. 1998;351(9106):857–61.PubMed
7.
Zurück zum Zitat Cole MG, Ciampi A, Belzile E, Zhong L. Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age Ageing. 2009;38(1):19–26.PubMed Cole MG, Ciampi A, Belzile E, Zhong L. Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age Ageing. 2009;38(1):19–26.PubMed
8.
Zurück zum Zitat Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.PubMed Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.PubMed
9.
Zurück zum Zitat Gretschel S, Estevez-Schwarz L, Hunerbein M, Schneider U, Schlag PM. Gastric cancer surgery in elderly patients. World J Surg. 2006;30(8):1468–74.PubMed Gretschel S, Estevez-Schwarz L, Hunerbein M, Schneider U, Schlag PM. Gastric cancer surgery in elderly patients. World J Surg. 2006;30(8):1468–74.PubMed
10.
Zurück zum Zitat Honda S, Furukawa K, Nishiwaki N, Fujiya K, Omori H, Kaji S, et al. Risk factors for postoperative delirium after gastrectomy in gastric cancer patients. World J Surg. 2018;42:3669–75.PubMed Honda S, Furukawa K, Nishiwaki N, Fujiya K, Omori H, Kaji S, et al. Risk factors for postoperative delirium after gastrectomy in gastric cancer patients. World J Surg. 2018;42:3669–75.PubMed
11.
Zurück zum Zitat Siddiqi N, Harrison JK, Clegg A, Teale EA, Young J, Taylor J, et al. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2016;3:Cd005563.PubMed Siddiqi N, Harrison JK, Clegg A, Teale EA, Young J, Taylor J, et al. Interventions for preventing delirium in hospitalised non-ICU patients. Cochrane Database Syst Rev. 2016;3:Cd005563.PubMed
12.
Zurück zum Zitat Hsieh SJ, Ely EW, Gong MN. Can intensive care unit delirium be prevented and reduced? Lessons learned and future directions. Ann Am Thorac Soc. 2013;10(6):648–56.PubMedPubMedCentral Hsieh SJ, Ely EW, Gong MN. Can intensive care unit delirium be prevented and reduced? Lessons learned and future directions. Ann Am Thorac Soc. 2013;10(6):648–56.PubMedPubMedCentral
13.
Zurück zum Zitat Hatta K, Kishi Y, Wada K, Takeuchi T, Odawara T, Usui C, et al. Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial. JAMA Psychiatry. 2014;71(4):397–403.PubMed Hatta K, Kishi Y, Wada K, Takeuchi T, Odawara T, Usui C, et al. Preventive effects of ramelteon on delirium: a randomized placebo-controlled trial. JAMA Psychiatry. 2014;71(4):397–403.PubMed
14.
Zurück zum Zitat Al-Aama T, Brymer C, Gutmanis I, Woolmore-Goodwin SM, Esbaugh J, Dasgupta M. Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial. Int J Geriatr Psychiatry. 2011;26(7):687–94.PubMed Al-Aama T, Brymer C, Gutmanis I, Woolmore-Goodwin SM, Esbaugh J, Dasgupta M. Melatonin decreases delirium in elderly patients: a randomized, placebo-controlled trial. Int J Geriatr Psychiatry. 2011;26(7):687–94.PubMed
15.
Zurück zum Zitat Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370–9.PubMed Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, et al. Evaluation of delirium in critically ill patients: validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med. 2001;29(7):1370–9.PubMed
16.
Zurück zum Zitat Guenther U, Popp J, Koecher L, Muders T, Wrigge H, Ely EW, et al. Validity and reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients. J Crit Care. 2010;25(1):144–51.PubMed Guenther U, Popp J, Koecher L, Muders T, Wrigge H, Ely EW, et al. Validity and reliability of the CAM-ICU Flowsheet to diagnose delirium in surgical ICU patients. J Crit Care. 2010;25(1):144–51.PubMed
17.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.PubMedPubMedCentral Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.PubMedPubMedCentral
18.
Zurück zum Zitat Tei M, Ikeda M, Haraguchi N, Takemasa I, Mizushima T, Ishii H, et al. Risk factors for postoperative delirium in elderly patients with colorectal cancer. Surg Endosc. 2010;24(9):2135–9.PubMed Tei M, Ikeda M, Haraguchi N, Takemasa I, Mizushima T, Ishii H, et al. Risk factors for postoperative delirium in elderly patients with colorectal cancer. Surg Endosc. 2010;24(9):2135–9.PubMed
19.
Zurück zum Zitat Brouquet A, Cudennec T, Benoist S, Moulias S, Beauchet A, Penna C, et al. Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg. 2010;251(4):759–65.PubMed Brouquet A, Cudennec T, Benoist S, Moulias S, Beauchet A, Penna C, et al. Impaired mobility, ASA status and administration of tramadol are risk factors for postoperative delirium in patients aged 75 years or more after major abdominal surgery. Ann Surg. 2010;251(4):759–65.PubMed
20.
Zurück zum Zitat Koga Y, Tsuruta R, Murata H, Matsuo K, Ito T, Ely EW, et al. Reliability and validity assessment of the Japanese version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Intensive Crit Care Nurs. 2015;31(3):165–70.PubMed Koga Y, Tsuruta R, Murata H, Matsuo K, Ito T, Ely EW, et al. Reliability and validity assessment of the Japanese version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Intensive Crit Care Nurs. 2015;31(3):165–70.PubMed
21.
Zurück zum Zitat Neto AS, Nassar AP Jr, Cardoso SO, Manetta JA, Pereira VG, Esposito DC, et al. Delirium screening in critically ill patients: a systematic review and meta-analysis. Crit Care Med. 2012;40(6):1946–51.PubMed Neto AS, Nassar AP Jr, Cardoso SO, Manetta JA, Pereira VG, Esposito DC, et al. Delirium screening in critically ill patients: a systematic review and meta-analysis. Crit Care Med. 2012;40(6):1946–51.PubMed
22.
Zurück zum Zitat Kiely DK, Jones RN, Bergmann MA, Marcantonio ER. Association between psychomotor activity delirium subtypes and mortality among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci. 2007;62(2):174–9.PubMed Kiely DK, Jones RN, Bergmann MA, Marcantonio ER. Association between psychomotor activity delirium subtypes and mortality among newly admitted post-acute facility patients. J Gerontol A Biol Sci Med Sci. 2007;62(2):174–9.PubMed
23.
Zurück zum Zitat Benoit AG, Campbell BI, Tanner JR, Staley JD, Wallbridge HR, Biehl DR, et al. Risk factors and prevalence of perioperative cognitive dysfunction in abdominal aneurysm patients. J Vasc Surg. 2005;42(5):884–90.PubMed Benoit AG, Campbell BI, Tanner JR, Staley JD, Wallbridge HR, Biehl DR, et al. Risk factors and prevalence of perioperative cognitive dysfunction in abdominal aneurysm patients. J Vasc Surg. 2005;42(5):884–90.PubMed
24.
Zurück zum Zitat Marcantonio ER, Juarez G, Goldman L, Mangione CM, Ludwig LE, Lind L, et al. The relationship of postoperative delirium with psychoactive medications. JAMA. 1994;272(19):1518–22.PubMed Marcantonio ER, Juarez G, Goldman L, Mangione CM, Ludwig LE, Lind L, et al. The relationship of postoperative delirium with psychoactive medications. JAMA. 1994;272(19):1518–22.PubMed
26.
Zurück zum Zitat Leung JM, Sands LP, Vaurio LE, Wang Y. Nitrous oxide does not change the incidence of postoperative delirium or cognitive decline in elderly surgical patients. Br J Anaesth. 2006;96(6):754–60.PubMed Leung JM, Sands LP, Vaurio LE, Wang Y. Nitrous oxide does not change the incidence of postoperative delirium or cognitive decline in elderly surgical patients. Br J Anaesth. 2006;96(6):754–60.PubMed
27.
Zurück zum Zitat American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46. American Geriatrics Society. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2015;63(11):2227–46.
28.
Zurück zum Zitat Hatta K, Kishi Y, Wada K, Takeuchi T, Ito S, Kurata A, et al. Preventive effects of suvorexant on delirium: a randomized placebo-controlled trial. J Clin Psychiatry. 2017;78(8):e970–9.PubMed Hatta K, Kishi Y, Wada K, Takeuchi T, Ito S, Kurata A, et al. Preventive effects of suvorexant on delirium: a randomized placebo-controlled trial. J Clin Psychiatry. 2017;78(8):e970–9.PubMed
29.
Zurück zum Zitat Liu C, Weaver DR, Jin X, Shearman LP, Pieschl RL, Gribkoff VK, et al. Molecular dissection of two distinct actions of melatonin on the suprachiasmatic circadian clock. Neuron. 1997;19(1):91–102.PubMed Liu C, Weaver DR, Jin X, Shearman LP, Pieschl RL, Gribkoff VK, et al. Molecular dissection of two distinct actions of melatonin on the suprachiasmatic circadian clock. Neuron. 1997;19(1):91–102.PubMed
30.
Zurück zum Zitat Gredin MJ, Masana MI, Rivera-Bermudez MA, Hudson RL, Eamest DJ, Gillette MU, et al. Melatonin desensitizes endogenous MT2 melatonin receptors in the rat suprachiasmatic nucleus: relevance for defining the periods of sensitivity of the mammalian circadian clock to melatonin. FASEB J. 2004;18(14):1646–56. Gredin MJ, Masana MI, Rivera-Bermudez MA, Hudson RL, Eamest DJ, Gillette MU, et al. Melatonin desensitizes endogenous MT2 melatonin receptors in the rat suprachiasmatic nucleus: relevance for defining the periods of sensitivity of the mammalian circadian clock to melatonin. FASEB J. 2004;18(14):1646–56.
Metadaten
Titel
A phase II study of ramelteon for the prevention of postoperative delirium in elderly patients undergoing gastrectomy
verfasst von
Shinsaku Honda
Kenichiro Furukawa
Rie Makuuchi
Tomoyuki Irino
Masanori Tokunaga
Yutaka Tanizawa
Etsuro Bando
Taiichi Kawamura
Kaori Shinsato
Teruaki Matsumoto
Masanori Terashima
Publikationsdatum
08.07.2020
Verlag
Springer Singapore
Erschienen in
Surgery Today / Ausgabe 12/2020
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-020-02073-9

Weitere Artikel der Ausgabe 12/2020

Surgery Today 12/2020 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

Karpaltunnelsyndrom BDC Leitlinien Webinare
CME: 2 Punkte

Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.