#Delirium #Surgery #Melatonin #Prevention #Cognition #Sleep #Geriatrics #Anesthesia
Postoperative delirium (POD) is a common disorder in elderly patients
following surgery. It manifests as attention, perception, and cognitive
disturbances, potentially leading to severe complications. POD increases the
risk of cognitive decline, loss of autonomy, and mortality.
Unfortunately, few effective treatments exist once delirium has set in. The
medications used often have significant side effects, particularly in older
adults. This makes prevention essential to reducing risks and improving patient
recovery.
Among the approaches studied, melatonin could be a promising solution.
This hormone, which regulates the sleep-wake cycle, also plays a role in
cognition and mood. Sleep disturbances and circadian rhythm disruptions are
frequently observed in patients with POD, suggesting that melatonin might help
prevent this condition.
However, study results remain uncertain. Some research shows a beneficial
effect in reducing POD, while others find no difference compared to a placebo.
These discrepancies may stem from variations in dosage, treatment duration, or
evaluation methods.
In this context,
this study explores the effectiveness of melatonin in
preventing postoperative delirium in elderly patients, analyzing its impact on
POD incidence, sleep quality, and postoperative recovery.
Melatonin: miracle or mirage against POD?
This study included 120 patients over the age of 65 undergoing
non-cardiac surgery. Participants were randomly assigned to two groups:
- Melatonin
group: Administration of
3 mg of melatonin before surgery and for seven days postoperatively.
- Placebo
group: Identical protocol
without melatonin.
Patients were monitored during hospitalization and for three months
after surgery. Evaluation criteria included POD incidence, sleep quality,
length of hospital stay, and cognitive status at three months.
The findings indicate that
POD incidence was similar between the two
groups (16.3% in the melatonin group vs. 4.9% in the placebo group), with no
statistically significant difference.
No notable improvement in sleep quality
or other clinical parameters was observed. Despite high adherence to treatment
(92.9%), the study was prematurely discontinued due to
recruitment difficulties
and pandemic-related constraints.
A hope… or just a dream?
Postoperative delirium is a frequent complication in elderly patients,
associated with increased morbidity, mortality, and prolonged hospital stays.
Its management remains a challenge due to the lack of effective treatments,
making
prevention crucial. This study investigates the impact of perioperative
melatonin administration on POD incidence by targeting sleep regulation and
circadian rhythms.
Although melatonin was
well tolerated,
it did not demonstrate
significant efficacy in preventing POD. No notable improvement was observed in
sleep quality, cognitive status, or hospitalization rates between the melatonin
and placebo groups.
However,
the study’s early termination limits its statistical power and
weakens the robustness of its conclusions. Additionally, pandemic-related
constraints hindered patient recruitment and follow-up, potentially influencing
the results. To definitively establish melatonin’s effectiveness in POD
prevention,
a larger-scale study (>1000 patients) is needed. This future
research should incorporate
methodological adjustments, including
optimized
patient selection,
extended follow-up, and
more precise evaluation criteria.
Preventing POD remains a major challenge in anesthesia and geriatrics,
requiring a combination of pharmacological and non-pharmacological strategies.
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