Postoperative delirium after pharyngolaryngectomy with esophagectomy: a role for ramelteon and suvorexant

Eisuke Booka, Yasuhiro Tsubosa, Teruaki Matsumoto, Mari Takeuchi, Takashi Kitani, Masato Nagaoka, Atsushi Imai, Tomoyuki Kamijo, Yoshiyuki Iida, Ayako Shimada, Katsushi Takebayashi, Masahiro Niihara, Keita Mori, Tetsuro Onitsuka, Hiroya Takeuchi, Yuukou Kitagawa

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Abstract

Background: Postoperative delirium is common after extensive surgery, and is known to be associated with sleeping medications. In this study, we aimed to investigate the relationships between sleeping medications and postoperative delirium after pharyngolaryngectomy with esophagectomy. Methods: We performed a retrospective analysis of 65 patients who underwent pharyngolaryngectomy with esophagectomy at Shizuoka Cancer Center Hospital between January 2012 and March 2016. All data were assessed by two psychiatrists, and univariate and multivariate analyses were performed. Results: Postoperative delirium developed in 9 (13.8%) patients, with most cases (77.8%) occurring between postoperative day (POD) 1 and POD 3. Of the 24 patients taking a minor tranquilizer after surgery, 8 (33.3%) became delirious, but, of the remaining 41 patients taking ramelteon with or without suvorexant, only one (2.4%) became delirious after surgery. Moreover, of the 16 patients taking both ramelteon and suvorexant, no postoperative delirium was observed. Ramelteon with or without suvorexant was significantly associated with a decreased rate of postoperative delirium compared with minor tranquilizer use (p = 0.001). Multivariate analysis confirmed that the use of ramelteon with or without suvorexant was the only significant preventive factor of postoperative delirium (odds ratio 0.060, p = 0.013). Conclusion: The use of ramelteon with or without suvorexant was the only significant preventive factor of postoperative delirium after pharyngolaryngectomy with esophagectomy. However, using minor tranquilizers was associated with postoperative delirium. We recommend ramelteon with or without suvorexant for preventing postoperative delirium after pharyngolaryngectomy with esophagectomy.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalEsophagus
DOIs
Publication statusAccepted/In press - 2017 Jan 21

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Keywords

  • Minor tranquilizers
  • Pharyngolaryngectomy with esophagectomy
  • Postoperative delirium
  • Ramelteon
  • Suvorexant

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Booka, E., Tsubosa, Y., Matsumoto, T., Takeuchi, M., Kitani, T., Nagaoka, M., Imai, A., Kamijo, T., Iida, Y., Shimada, A., Takebayashi, K., Niihara, M., Mori, K., Onitsuka, T., Takeuchi, H., & Kitagawa, Y. (Accepted/In press). Postoperative delirium after pharyngolaryngectomy with esophagectomy: a role for ramelteon and suvorexant. Esophagus, 1-6. https://doi.org/10.1007/s10388-017-0570-z