Benzodiazepine-Free Cardiac Anesthesia for Reduction of Postoperative Delirium

作者：Jessica Spence, P.J. Devereaux, Shun-Fu Lee, Frédérick D’Aragon, Michael S. Avidan, Richard Whitlock, C. David Mazer, Nicolas Rousseau‐Saine, Raja Rajamohan, Kane O. Pryor, Rael Klein, Edmund Tan, Matthew Cameron, Emily Di Sante, Erin DeBorba, M. Mustard, Étienne J. Couture, Raffael Pereira Cezar Zamper, Michael R. Law, George Djaiani, Tarit Saha, Stephen Choi, Peter Hedlin, D. Ryan Pikaluk, Wing Lam, Alain Deschamps, Chinthanie Ramasundarahettige, Jessica Vincent, William F. McIntyre, Simon Oczkowski, Braden J. Dulong, Christopher J. Beaver, Shelley Kloppenburg, André Lamy, Eric Jacobsohn, Emilie P. Belley‐Côté, George Wyse, John W. Eikelboom, Tara M. Robinson, Gladys Marfo, Kumar Balasubramanian, Peter Koh, Courtney Mullen, Leah Hayward, Matthew Ryan McFarling, Kim Botsford, Summer Syed, Maia Shen, Renee Fournier, Morvarid Kavosh, Kate MacKenzie, Marita Monterola, Linda Girling, Mathilde St-Pierre, Michel-Antoine Perreault, Étienne de Médicis, Jonathan Gaulin, N Edward, Ron Ree, Iris Yao, Clement Chui, Michelle Biferie, Game Cj, Juliet Ann Atherstone, Darren Mullane, Juliet Atherstone, Michelle Mozel, Mikaela Barton, Ashley Scott, Aiman Hasnat, Ramiro Arellano, Robert Tanzola, Debbie DuMerton, Michael Cummings, Ahmad Alli, Samson Moses, Niloufar Siadati-Fini, Kyle Chin, Gregory M. T. Hare, Maliha Muneer, Izabela Panek, Kaela H Fraser, Flynn Bonazza, Sharon E Amey, Shelley Roulston, Sophie Robichaud, Marco Julien, Antoine Rochon, Marie-Ève Chamberland, Meggie Raymond, Jennifer Cogan, Georges Desjardins, Jean-Sébastien Lebon, Christian Ayoub, Pierre Couture, Athanase Courbe, Maria Rosal Martins, André Denault, Anita Wu, Kristofer Beggs, Stéphanie Jarry, Sarah Bendaoud, Ester Cisneros-Aguilera, Lana Agoian, Melissa Laurendeau, E Duval, Anya Chabane, Martine Lacroix, Liam J Kennedy, Robert Mayer, Michelle Clunie, Azeez Akinlade, Hugo Tremblay, Nathalie Gagné, Annie Bergeron, François Laforge, Audrey Grenier, Valérie Morin, Sandrine Bellavance, Valérie Lafrenière‐Bessi, Béatrice Martin, Joanie Lachance, Olivier Audet, Léa Vachon-Zicat, Yasmine Babaki, Élizabeth St-Onge, Nelson Lavoie, Bisson Mr, Marie-Ève Charest, Angela Jerath, Lilia Kaustov, Andrew Fleet, Sophia Wong, Elizabeth Lappin, shagufta shaheen, Mohammad A. Helwani, Thaddeus P. Budelier, Arianna Montes de, Alex Kronzer, Meghann M. Fitzgerald, Leonard N. Girardi, Leonard N. Girardi, Michele Steinkamp, Lisbeth Evered, Hannah R Leibowitz, Dylan R Bitensky, Lisbeth Evered, Alexis F. Turgeon, André Denault, Daniel McIssac, Kathryn Sparrow, Manoj M. Lalu, Stuart A. McCluskey, Richard Hall, W. Scott Beattie · 发表于：JAMA Surgery · 年份：2025 · DOI：10.1001/jamasurg.2024.6602 · 被引用次数：29 · 研究领域：Intensive Care Unit Cognitive Disorders、Family and Patient Care in Intensive Care Units、Frailty in Older Adults

Importance: Delirium is common after cardiac surgery and associated with adverse outcomes. Intraoperative benzodiazepines may increase postoperative delirium but restricting intraoperative benzodiazepines has not yet been evaluated in a randomized trial. Objective: To determine whether an institutional policy of restricted intraoperative benzodiazepine administration reduced the incidence of postoperative delirium. Design, Setting, and Participants: This pragmatic, multiperiod, patient- and assessor-blinded, cluster randomized crossover trial took place at 20 North American cardiac surgical centers. All adults undergoing open cardiac surgery at participating centers during the trial period were included through a waiver of individual patient consent between November 2019 and December 2022. Intervention: Institutional policies of restrictive vs liberal intraoperative benzodiazepine administration were compared. Hospitals (clusters) were randomized to cross between the restricted and liberal benzodiazepine policies 12 to 18 times over 4-week periods. Main Outcomes and Measures: The primary outcome was the incidence of delirium within 72 hours of surgery as detected in routine clinical care, using either the Confusion Assessment Method-Intensive Care Unit or the Intensive Care Delirium Screening Checklist. Intraoperative awareness by patient report was assessed as an adverse event. Results: During the trial, 19 768 patients (mean [SD] age, 65 [12] years; 14 528 [73.5%] male) und...