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ANESTHETIC PHARMACOLOGY

Melatonin for Treatment and Prevention of Postoperative Delirium

Department of Anesthesiology, Long Island Jewish Medical Center, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York

Address correspondence and reprint requests to Michael Hanania, MD, Director of Pain Management, Long Island Jewish Medical Center, Department of Anesthesiology, New Hyde Park, NY 11040. Address e-mail to mhanania{at}lij.edu

Postoperative delirium is a common problem associated with increased morbidity and mortality, prolonged hospital stay, additional tests and consultations and therefore, increased cost (1,2). The reported incidence of delirium or confusion after surgery ranges from 8% to 78% (2,3–5), depending on methods and population studied. The elderly seem to be at significantly increased risk for this complication.

Sleep-wake cycle disruption has been associated with delirium and behavioral changes (5) and sleep deprivation can even result in psychosis (6). Environmental changes (i.e., hospital stay), medications, and general anesthesia can affect the sleep-wake cycle (3,4). Plasma melatonin levels, which play an important role in the regulation of the sleep-wake cycle, are decreased after surgery (18) and in hospitalized patients (7,11).

We report the successful use of melatonin in treating severe postoperative delirium unresponsive to antipsychotics or benzodiazepines in one patient. In another patient with a history of postoperative delirium, melatonin was used to prevent another episode of delirium after repeat lower extremity surgery.

IMPLICATIONS: Postoperative delirium or confusion after surgery is a common problem associated with complications and death. Delirium has been linked to sleep-wake cycle disruption. Melatonin levels, which play an important role in regulating the sleep-wake cycle, are decreased after surgery. Two cases are presented where melatonin was used to treat and prevent postoperative delirium.

This article has been cited by other articles:

				B. Yildizeli, M. Oguzhan Ozyurtkan, H. F. Batirel, K. Kuscu, N. Bekiroglu, and M. Yuksel Factors Associated With Postoperative Delirium After Thoracic Surgery Ann. Thorac. Surg., March 1, 2005; 79(3): 1004 - 1009. [Abstract] [Full Text] [PDF]

				O. A. Ajilore and A. Kumar Delirium and Dementia Focus, April 1, 2004; 2(2): 210 - 220. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999