Delirium in the Postoperative Cardiac Patient: A Review

Background and aim of review: Cardiac surgery is increasingly common and relatively safe, but there are frequent reports of neuropsychiatric sequelae occurring in the postoperative period. One of the most common neuropsychiatric presentations of cardiac surgery is delirium, also called postcardiotomy delirium (PCD). Despite the vast numbers of cardiac surgeries performed today, there is a paucity of data on risk factors and management options of PCD available to the clinician. This review aims to summarize available information, increase clinicians' awareness of PCD and suggest effective management of this illness. Methods: Our literature search was completed using the databases Medline and CINAHL; it was limited to human and English language studies from 1964 to the present. Search terms included “delirium,”“agitation,”“postoperative,”“cardiac,”“neuropsychiatric,”“neuroleptics,”“psychosis,”“surgery,”“treatment,”“postcardiotomy,” and “pharmacotherapy.”Results: Our review of the literature revealed several risk factors for PCD, as well as various options for its pharmacological management. Conclusions: A multifactorial model should be applied when considering risk stratification for and prevention of delirium postoperatively. Pharmacologically, conventional antipsychotic agents, such as haloperidol, have long been used to manage delirium. In light of haloperidol's side effects, particularly those applicable to the cardiac patient, further research is required into the role of second generation antipsychotics. These agents are common in clinical use, and may be the preferred medications.