IV Acetaminophen prevents post op delirium

Intravenous acetaminophen (paracetamol) when added to a sedative has been found to reduce the risk of postoperative delirium in patients after cardiac surgery [1]. Post operative delirium is common after surgery in elderly persons. It often increases the length of hospital stay and naturally the expenses and has adverse effects on final outcome.

The DEXACET Randomized Clinical Trial randomized 120 elderly patients undergoing coronary artery bypass surgery (CABG) or combine CABG/valve surgery. Four groups received either intravenous acetaminophen or placebo and sedative IV propofol vs dexmedetomidine. Primary outcome measured in the trial was the occurrence of postoperative delirium, which was assessed by the Confusion Assessment Method. Secondary outcomes measured were the duration of delirium, cognitive decline, breakthrough analgesia within 48 hours, length of stay in the intensive care unit and length of hospital stay.

Patients receiving acetaminophen had a significantly lower rate of delirium of 10% vs 28% with placebo (P=0.01). There was no significant difference in delirium between dexmedetomidine and propofol (17% vs 21%; P=0.54).

Reference

1. Subramaniam B, Shankar P, Shaefi S, Mueller A, O’Gara B, Banner-Goodspeed V, Gallagher J, Gasangwa D, Patxot M, Packiasabapathy S, Mathur P, Eikermann M, Talmor D, Marcantonio ER. Effect of Intravenous Acetaminophen vs Placebo Combined With Propofol or Dexmedetomidine on Postoperative Delirium Among Older Patients Following Cardiac Surgery: The DEXACET Randomized Clinical Trial. JAMA. 2019 Feb 19;321(7):686-696.