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DEXACET: Acetaminophen with propofol dexmedetomidine decreases delirium after CABG
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Patients who received IV acetaminophen with IV propofol or dexmedetomidine after cardiac surgery had a decreased risk for in-hospital delirium compared with those who received placebo, according to a study published in JAMA.
“To our knowledge, this study is the first to show a significant and meaningful reduction of delirium with use of IV acetaminophen in patients undergoing cardiac surgery,” Balachundhar Subramaniam, MD, MPH, associate professor of anesthesia at Beth Israel Deaconess Medical Center, and colleagues wrote.
Patients undergoing CABG
Researchers analyzed data from 120 patients aged 60 years or older who underwent CABG with or without mitral and/or aortic valve replacement and required cardiopulmonary bypass between September 2015 and April 2018. Patients were assigned acetaminophen or placebo for an adjunct analgesic and dexmedetomidine or propofol for a sedative. Postoperative analgesia was administered every 6 hours for 48 hours, and postoperative sedation was given to patients for up to 6 hours.
The treatment groups in the study were the following:
cetaminophen and dexmedetomidine (n = 29; median age, 64 years; 90% men)
lacebo and dexmedetomidine (n = 30; median age, 69 years; 83% men)
cetaminophen and propofol (n = 31; median age, 70 years; 77% men) and
lacebo and propofol (n = 30; median age, 71 years; 87% men).
The primary outcome of interest was the incidence of postoperative in-hospital delirium throughout the duration of a patient’s hospital stay. Secondary outcomes of interest were defined as postoperative cognition at discharge, duration of delirium, 48-hour breakthrough analgesic requirements and hospital and ICU lengths of stay. Adverse event such as hypotension were also assessed
In-hospital delirium
Patients assigned acetaminophen had a lower incidence of in-hospital delirium vs. those assigned placebo (10% vs. 28%; P = .01). Both of these groups had significant differences for the time to delirium onset (HR = 2.8; 95% CI, 1.1-7.8). The dexmedetomidine and propofol groups had no significant differences for the incidence of delirium (17% vs. 21%)
Compared with patients assigned placebo, those assigned acetaminophen had shorter durations of delirium (1 day vs. 2 days; ), shorter ICU lengths of say (median 29.5 hours vs. 46.7 hours; ) and less breakthrough analgesia requirements (median 322.5 g morphine equivalents vs. 405.3 g morphine equivalents; ).
The only significant difference in the secondary outcome in the dexmedetomidine and propofol groups was for breakthrough analgesia (median 328.8 g vs. 397.5 g; )
Hypotension was seen in 46% of patients assigned placebo/dexmedetomidine, 45% assigned acetaminophen/propofol, 24% assigned acetaminophen/dexmedetomidine and 23% assigned placebo/propofol.
“Additional research, including comparison of IV vs. oral acetaminophen and other potentially opioid-sparing analgesics on the incidence of postoperative delirium, is warranted,” Subramaniam and colleagues wrote. – by Darlene Dobkowski
Disclosures: The study was funded by Mallinckrodt Pharmaceuticals. Subramaniam reports he received grant support from Mallinckrodt Pharmaceuticals and funds from the NIH. Please see the study for all other authors’ relevant financial disclosures.
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