Effect Of Haloperidol On Postoperative Delirium Incidence In Elderly Patients Undergoing Hip Replacement Surgery

Objective Postoperative delirium?POD?is an acute brain dysfunction syndrome clinically manifesting as a disturbed state of consciousness and cognitive impairment,one of the serious complications in the elderly after surgery.Postoperative delirium will have a extremely serious negative effect on the patient's short and long-term rehabilitation,requiring immediate diagnosis and emergency medical treatment.Haloperidol is a most commonly used drug for the prevention and treatment of postoperative delirium,with sedative and anxiolytic effects.This study was designed to investigate the effect of haloperidol on postoperative delirium in elderly patients following hip replacement surgery.Methods This was a randomized double-blinded placebo controlled trials which approved by the Medical Ethics Committee of the Fourth Affiliated Hospital of Anhui Medical University.A total of 60 elderly patients with hip replacement surgery,34males and 26 females,aged 65-85 years,ASA physical status???,were enrolled in this study.All patients were randomly divided into two groups:haloperidol group?group H?and control group?group C?with 30 cases each.The same general anesthesia and I-gel laryngeal mask airway procedure have been used in both groups of patients,They were given patient-controlled intravenous analgesia?PCIA?after operation.Group H:sufentanil 2?g/kg+flurbiprofen 3 mg/kg+haloperidol 5mg;group C:sufentanil 2?g/kg+flurbiprofen 3 mg/kg,all of added into 0.9%Sodium chloride injection to 100 ml,Intravenous infusion was continued at the rate of 2 ml/h for 48 h.The intraoperation of fluid intake,amount of bleeding,urine volume,operation time,and all medications during surgery were recorded.The parameters of systolic blood pressure?SBP?,diastolic blood pressure?DBP?,heart rate?HR?,pulse oxygen saturation?SpO₂?were recorded in 1,6,12,24,36 and 48 hours after surgery.The value of Ramsay scores and VAS scores were observed in 1,6,12,24,36 and 48 hours after surgery.The quality of sleep was recorded on the 1st to 3rd night after surgery.The rate of postoperative delirium was evaluated by confusion assessment method?CAM?.The adverse effects of postoperative hypertension and hypotension,tachycardia and bradycardia,arrhythmia,extrapyramidal symptoms,somnolence,and nausea and vomiting were recorded.Results There were no significant difference in gender,age,body weight,body mass index?BMI?,score of the mini–mental state examination?MMSE?between the two groups?P>0.05?.there were no significant differences in the transfusion volume,colloidal fluid volume,bleeding volume,urine volume,operation time between the two groups?P>0.05?.There was no significant difference in the doses of midazolam,cis-atracurium,sufentanil,etomidate,propofol,remifentanil between the two groups?P>0.05?.Compared with group C,SBP and DBP of group H decreased significantly?P<0.05?and HR decreased significantly at 6 and 12 hours after surgery?P<0.05?.There was no significant difference in SpO₂ between two groups.Compared with group C,the Ramsay scores of group H at 6h and 12h after surgery were significantly higher than that in group C?P<0.05?.The Ramsay scores at 1h,6h and 12h after surgery were significantly higher than that in same group?P<0.05?.Compared with group C,VAS scores of group H decreased significantly at 6h and 12h after surgery.?P<0.05?.The quality of sleep scores in 1st and 3rd night were significantly lower than that in group C?P<0.05?.The incidence rate of postoperative delirium of group H was significantly lower?6.7%?than that in group C?30.0%??P<0.05?.There were no significant differences in the incidence of adverse reactions of postoperative hypertension and hypotension,tachycardia and bradycardia,arrhythmia,extrapyramidal symptoms,and somnolence between the two groups?P>0.05?.The incidence rate of postoperative nausea and vomiting?PONV?of group H was significantly lower?6.7%?than that in group C?26.7%??P<0.05?.Conclusion Haloperidol 5 mg added to patient controlled intravenous analgesia?PCIA?is effective in reducing the incidenc rate of postoperative delirium,Improving sleep quality of patients and reducing adverse reactions such as nausea and vomiting,establishing more stable hemodynamic and improving postoperative outcome in elderly patients undergoing hip replacement surgery.