High‐dose preoperative glucocorticoid for prevention of emergence and postoperative delirium in liver resection: A double‐blinded randomized clinical trial substudy

Background Emergence delirium (ED) and postoperative delirium (POD) are associated with increased morbidity and mortality and occur in up to one‐third of patients undergoing major non‐cardiac surgery, where the underlying pathogenesis is multifactorial, including increased inflammation. We aimed to assess the effect of pre‐operative high‐ versus low‐dose glucocorticoid on the occurrence of ED and POD. Methods This was a substudy from a randomized, double‐blinded clinical trial. Patients ≥18 years, undergoing open liver resection were randomized 1:1 to high‐dose (HD, 10 mg/kg methylprednisolone) or low‐dose (LD, 8 mg dexamethasone) glucocorticoid and assessed for ED and POD for a maximum of 4 days during hospitalization. The 3‐min Diagnostic Interview for CAM‐defined delirium (3D‐CAM) was used for assessment, 15 and 90 min after arrival in the post‐anesthesia care unit (PACU), and subsequently once daily in the ward. Results Fifty‐three patients were included in this secondary substudy (26 HD‐group and 27 LD‐group). ED occurred in n = 5 HD versus n = 6 LD patients 15 min after PACU arrival. At 90 min after PACU arrival, 4 patients had ED, all from LD‐group, and resulted in significantly longer PACU admission, 273 versus 178 min in ED versus Non‐ED patients. During the first 4 days in the ward, n = 5 patients had at least one occurrence of POD, all from LD‐group. Conclusions The primary finding of the current substudy was a lower occurrence of ED/POD in the PACU 90 min after arrival and during the first four postoperative days in patients receiving high‐dose glucocorticoid compared with patients receiving low‐dose glucocorticoid. The two study groups were not evenly balanced concerning known explanatory factors, i.e., age and size of surgery, which calls for larger studies to elucidate the matter.