Abstract
BackgroundHepatectomy is a highly invasive procedure with a high probability of postoperative delirium. Treatment with antiulcer drugs is indispensable after hepatectomy for anastomotic ulcer management. The clinical pathway for hepatectomy was reviewed and the antiulcer drug used was switched from famotidine, a H2-receptor antagonist, to omeprazole, a proton pump inhibitor, owing to the pharmacist’s intervention.MethodsHepatectomized recipients over 65 years of age, except in the cases of laparoscopic surgery and intensive care unit entry, were treated with famotidine injections (10 patients) or omeprazole injections (11 patients), and the incidence rates and severity of delirium were compared between the famotidine and omeprazole groups. The delirium after hepatectomy was assessed using the Japanese version of the NEECHAM confusion scale.ResultsThe incidence rates of delirium were 90% in the famotidine group and 27.3% in the omeprazole group. Four out of 9 recipients in the famotidine group were injected with haloperidol to treat for delirium, but no recipients needed this treatment in the omeprazole group.ConclusionsCompared with famotidine, the use of omeprazole was found to be effective in reducing the incidence rate and severity of postoperative delirium in patients undergoing hepatectomy. Pharmacists should actively strive to mitigate the risks of delirium.
Highlights
Postoperative delirium refers to the mental dysfunction associated with disturbances in consciousness that are of acute onset and triggered by operative stress
The insertion of multiple drains and waking after the onset of sleep owing to conditions that require complex postoperative management are precipitating factors that increase the likelihood of postoperative delirium
Before the clinical pathway was switched, patients who underwent hepatectomy were treated with famotidine before and after the clinical pathway was switched, patients were treated with omeprazole
Summary
Postoperative delirium refers to the mental dysfunction associated with disturbances in consciousness that are of acute onset and triggered by operative stress. It is a prognosis-related factor of quality of life and results in a high strain on the patient’s family and medical staff. It has negative effects, such as increased medical costs due to prolonged hospital stays; the implementation of premeasures for dealing with postoperative delirium, including measures for its appropriate assessment. Treatment with antiulcer drugs, which are indispensable after hepatectomy for anastomotic ulcer management, can increase the incidence of postoperative delirium. The clinical pathway for hepatectomy was reviewed and the antiulcer drug used was switched from famotidine, a H2-receptor antagonist, to omeprazole, a proton pump inhibitor, owing to the pharmacist’s intervention
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