N015 Dexmedetomidine in Management of Agitated Delirium in the Postoperative Cardiac Surgery Patient

Abstract

Delirium is a reversible organic mental syndrome whose chief characteristic is anxiety. When excessive motor activity is associated with delirium it is referred to as agitated delirium. Delirium occurs in 80% of intensive care unit (ICU) patients and is associated with prolonged length of stay (LOS) and increased mortality. In the postoperative cardiac surgery patient agitated delirium can result in difficulty breathing causing ventilator dyssynchony, hypertension, tachycardia, and combative behaviour. The risk of prolonged ventilation and integrity of sternal incisions are very real complications.The diagnosis and pharmacological management of delirium is an important quality of care issue for the postop cardiac surgery patient. Pharmacoeconomics involves the right drug, the right dose, at the right time and by the right route. Typically neuroleptics such as haloperidol and a combination of benzodiazepines namely ativan are used to treat delirium but neither have any analgesia properties. Dexmedetomidine (Dex) has a rapid onset and provides sedation and analgesia with no respiratory depression and can be used as a bridge to weaning mechanical ventilation.A review of two challenging patients will be used to describe our experience using Dex as an alternative to managing postoperative delirium. The pharmacologic management in the cardiac surgical patient in these times of economic constraints has stimulated interest in early extubation or fast track pathways. A brief discussion on a study with Dex will be discussed. Delirium is a reversible organic mental syndrome whose chief characteristic is anxiety. When excessive motor activity is associated with delirium it is referred to as agitated delirium. Delirium occurs in 80% of intensive care unit (ICU) patients and is associated with prolonged length of stay (LOS) and increased mortality. In the postoperative cardiac surgery patient agitated delirium can result in difficulty breathing causing ventilator dyssynchony, hypertension, tachycardia, and combative behaviour. The risk of prolonged ventilation and integrity of sternal incisions are very real complications. The diagnosis and pharmacological management of delirium is an important quality of care issue for the postop cardiac surgery patient. Pharmacoeconomics involves the right drug, the right dose, at the right time and by the right route. Typically neuroleptics such as haloperidol and a combination of benzodiazepines namely ativan are used to treat delirium but neither have any analgesia properties. Dexmedetomidine (Dex) has a rapid onset and provides sedation and analgesia with no respiratory depression and can be used as a bridge to weaning mechanical ventilation. A review of two challenging patients will be used to describe our experience using Dex as an alternative to managing postoperative delirium. The pharmacologic management in the cardiac surgical patient in these times of economic constraints has stimulated interest in early extubation or fast track pathways. A brief discussion on a study with Dex will be discussed.